title: Army Active Duty Members' Linkage to Veterans Health Administration Services After Deployments to Iraq or Afghanistan and Following Separation.
abstract: This study described the rate and predictors of Operation Enduring Freedom/Operation Iraqi Freedom active duty Army members' enrollment in and use of Veterans Health Administration (VHA) services (linkage), as well as variation in linkage rates by VHA facility. We used a multivariate mixed effect regression model to predict linkage to VHA, and also calculated linkage rates in the catchment areas of each facility (n = 158). The sample included 151,122 active duty members who deployed to Iraq or Afghanistan and then separated from the Army between fiscal years 2008 and 2012. Approximately 48% of the active duty members separating utilized VHA as an enrollee within one year. There was significant variation in linkage rates by VHA facilities (31-72%). The most notable variables associated with greater linkage included probable serious injury during index deployment (odds ratio = 1.81), separation because of disability (odds ratio = 2.86), and various measures of receipt of VHA care before and after separation. Information about the individual characteristics that predict greater or lesser linkage to VHA services can be used to improve delivery of health care services at VHA as well as outreach efforts to active duty Army members.
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (MPD:152), Menlo Park, CA 94025.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Vanneman
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (MPD:152), Menlo Park, CA 94025.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (MPD:152), Menlo Park, CA 94025.
authors.forename: Cheng
authors.initials: C
authors.lastname: Chen
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street (MS 035), Waltham, MA 02454.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Mohr
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street (MS 035), Waltham, MA 02454.
authors.forename: Rachel Sayko
authors.initials: RS
authors.lastname: Adams
authors.affiliation: Analytics, Defense Health Agency, 7701 Arlington Boulevard, Suite 5101, Falls Church, VA 22042.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Williams
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street (MS 035), Waltham, MA 02454.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Larson
mesh_terms: D055826:Afghan Campaign 2001-; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans; D058014:Veterans Health