title: The Veterans Health Administration's traumatic brain injury clinical reminder screen and evaluation: Practice patterns.
abstract: The goals of this study were to describe clinical practice patterns associated with the Veterans Health Administration's (VHA's) Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and determine whether practice patterns vary by patient, provider, or facility characteristics. Veterans (N = 614) who had initial healthcare visits between 2008, and 2011 and who had previously completed the VHA's traumatic brain injury (TBI) screen and subsequent CTBIE were drawn from a national database. Participants were primarily male (95%) with a mean age of 29.8 yr (standard deviation = 8). Chart reviews were conducted on a random sample of charts with completed CTBIEs from 21 sites. Using a cross-sectional design, patient- and facility-specific variables were investigated as potential predictors of practice variation. During the study period, 79% of patients in this national sample were screened within 1 d of their initial healthcare visit and 65% were evaluated via CTBIE within 30 d of screening. Provider and participant characteristics were generally not associated with timeliness. The CTBIE was completed by individuals versus teams at comparable rates. Much of what occurred during the evaluation, beyond TBI-specific procedures, were medical assessments, such as review of medications and other substances.
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans' Hospital, Tampa, FL.|Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL; and Defense and Veterans Brain Injury Center, Silver Spring, MD.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Belanger
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: Gail
authors.initials: G
authors.lastname: Powell-Cope
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Spehar
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: Mark
authors.initials: M
authors.lastname: McCranie
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, Health Services Research & Development, James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: S Angelina
authors.initials: SA
authors.lastname: Klanchar
authors.affiliation: Department of Mental Health and Behavioral Sciences, W. G. (Bill) Hefner Department of Veterans Affairs Medical Center (VAMC), Salisbury, NC; and Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Ruth
authors.initials: R
authors.lastname: Yoash-Gantz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Clement J. Zablocki VAMC, Milwaukee, WI; and Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Kosasih
authors.affiliation: Department of Physical Medicine and Rehabilitation, Washington DC VAMC, Washington, DC.
authors.forename: Joel
authors.initials: J
authors.lastname: Scholten
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010818:Practice Patterns, Physicians'; D017064:Process Assessment, Health Care; D017010:Reminder Systems; D014481:United States; D014728:Veterans; D055815:Young Adult
keywords: TBI; Veterans Affairs; brain concussion; brain injuries; diagnosis; mass screening; practice patterns; practice variation; traumatic brain injury evaluation; traumatic brain injury screening