1. 1 Screening for Mild TBI in OEF-OIF Deployed Military: Empirical Assessment Ann Hendricks, PhD, Errol Baker, PhD, Martin Charns, DBA, John A. Gardner, PhD, Katherine M. Iverson, PhD, Rachel Kimerling, PhD, Maxine Krengel, PhD, Mark Meterko, PhD, Terri K. Pogoda, PhD, Kelly L. Stolzmann, MS VA Boston and Palo Alto Healthcare Systems Henry Lew, MD, PhD, DVBIC Jomana Amara, PhD, NPS Presented at the National HSR&D Meeting Washington, DC, February 18, 2011 Email: Ann.Hendricks@va.govAnn.Hendricks@va.gov

2. OUTLINE o Describe population o For VA patients with prior OEF/OIF deployments, estimate  Injuries  Patients with post-concussive syndrome o Classify amounts of VA utilization o Estimate costs to VA

3. DATA SOURCES  Patient Care Services electronic records o TBI Screenings o Comprehensive TBI Evaluations  DMDC records with o Deployments o Service and component o Rank/education before separation  VA Utilization o Gender/marital status

5. Patients by Screening Status Percent:DeployedScreenedPositive screen Evaluated Number:2,022,700216,33553,53624,461 Female18.112.36.35.8 Marriedn/a46.446.548.0 < High School80.867.870.970.6 Enlisted91.492.895.896.2 Army/Marines Any AF or Navy 58.5 41.5 28.9 22.6 39.5 10.1 49.2 9.0 <8 years service66.025.018.424.8

6. Calculating Rates of Injury Screened Patients 216,335 Positive Screens 53,536 CTE 24,461 Positive Screen Came for CTE TBI Negative Screen No CTE

7. Rate of TBI Among VA Patients with Prior Deployment  TBI “confirmed” out of all screened patients: 6.5% - 7.7%  If all patients with positive screens like those with CTE (strong assumption): 14.3% - 15.3% of all screened patients  What if patients who do not return for CTE are more likely to have persistent problems?

8. VA Services - Patients with CTE  ~75% had VA outpatient care in 2008  97% had VA outpatient care in 2009  Compared to men, women received: o more outpatient care (4 visits a year) o less inpatient care (~9 days fewer)

9. Cost per Patient, VA Services, by PTSD and TBI Status, FY 2008

10. Conclusions  VHA TBI screening process is inclusive o Offers follow-up evaluation to ~ 25% of screened servicemembers o Evaluated about 11% overall  Almost all of those with + screens receive further VHA care  Amount of VA health care greatest for patients with both TBI and PTSD