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MILITARY MEDICINE, 180, 4:374, 2013
H e a lth C a re U tiliz a tio n B e h a v io r o f V e te ra n s W h o D e p lo y e d to A fg h a n is ta n an d Iraq Seung-eun Lee, MPH*; Vincent P. Fonseca, MD*; Charles L. Wolters, M S f; Deborah D. Dougherty, P hD f; Col Michael R. Peterson, USAF (Ret.)f; Aaron I. Schneiderman, P hD f; Erick K. Ishii, P h D t
ABSTRACT Background: Previous assessments of Afghanistan/Iraq Veterans have lacked a systematic overview of all injury and illness experiences captured by the Veterans Health Administration (VHA) health care services. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them. Methods: A roster of service members who have served in Afghanistan/Iraq and became eligible for VHA care between 2002 and 2010 and their corresponding administrative VA medical encounter data were abstracted from the VHA Office of Public Health Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Health Surveillance System. Results: Between 2002 and 2010, approximately 55% of eligible Veterans accessed VHA health care. Higher utilization was observed among Veterans 50 years of age and older compared to younger Veterans. Higher utilization was also observed among Veterans with increasing cumulative deployment time. Mental disorder diagnostic codes accounted for the greatest number of visits per Veteran. Conclusions: Veterans with mental health diagnoses may need a different level of care than other VHA users. Other service factors associated with utilization require further research to better understand the underlying relationship. Current observed results may be reflective of future expected utilization patterns and may assist in resource planning and research.
INTRODUCTION Since 2001, over 2.4 million service members have served or are serving in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF] and Operation New Dawn [OND]).1 Many of these individuals (Veterans) are eligible for care from the Veterans Health Administration (VHA) as a result of separation from the military or discharge from active duty status as reservists or guardsmen. Veterans have reported a wide range of injuries, infections, and long term health issues after returning from deployment. Further more, extended deployment length and repeated deployments have made it a challenge to attribute health issues to specific aspects of deployment for Veterans.2 Numerous studies have focused on specific injuries or ill nesses of the Veteran population who use VHA care.3-5 How ever, previous assessments of the Afghanistan and Iraq Veteran population have lacked a systematic overview of all injury and illness experiences captured by the VHA health care services. Such an assessment may help give perspective to the relative *Intellica Corporation, 209 West Poplar Street, San Antonio, TX 78212. /Lockheed Martin, 2700 Prosperity Avenue Suite 200, Fairfax, VA 22031. /Epidemiology Program, Post-Deployment Health Group. Office of Public Health. Veterans Health Administration, Department of Veterans Affairs, 1717 H Street, NW, Washington, DC 20006. doi: 10.7205/MILMED-D-14-00250
374
frequency of medical conditions among Veterans as well as the amount of care used for these different conditions. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them—comparing across demographic and service fac tors, as well as features of deployment history such as total time deployed and number of deployments.
METHODS D a ta S o u rc e
All data for this analysis were abstracted from the VHA Office of Public Health OEF/OIF/OND Health Surveillance System. This system contains a roster of Veterans who have served in OEF/OIF/OND and have subsequently separated from the military or were discharged from active duty status. This provides the list of eligible Veterans as well as demo graphic and service characteristics such as sex, service, com ponent, rank, and OEF/OIF/OND deployment history. The roster is provided to Office of Public Health by the Depart ment of Defense (DoD) Defense Manpower Data Center. VA medical encounter data were taken from the administrative health care records, which include both ambulatory and inpa tient visits at VHA health care facilities. Medical diagnostic coding is defined by the International Classification of
MILITARY MEDICINE, Vol. 180, April 2015
Health Care Utilization Behavior of Veterans TA B LE I.
Characteristics of Veterans Who Are Eligible and Percentage Using VHA Health Care, by Component, 2002 to 2010 Demographic and Service Characteristics of Eligible Veterans Regular Component
Characteristics Total Veterans Sex Male Female Age (Years)'
r ie f
R
epo r ts
MILITARY MEDICINE, 180, 4:374, 2013
H e a lth C a re U tiliz a tio n B e h a v io r o f V e te ra n s W h o D e p lo y e d to A fg h a n is ta n an d Iraq Seung-eun Lee, MPH*; Vincent P. Fonseca, MD*; Charles L. Wolters, M S f; Deborah D. Dougherty, P hD f; Col Michael R. Peterson, USAF (Ret.)f; Aaron I. Schneiderman, P hD f; Erick K. Ishii, P h D t
ABSTRACT Background: Previous assessments of Afghanistan/Iraq Veterans have lacked a systematic overview of all injury and illness experiences captured by the Veterans Health Administration (VHA) health care services. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them. Methods: A roster of service members who have served in Afghanistan/Iraq and became eligible for VHA care between 2002 and 2010 and their corresponding administrative VA medical encounter data were abstracted from the VHA Office of Public Health Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Health Surveillance System. Results: Between 2002 and 2010, approximately 55% of eligible Veterans accessed VHA health care. Higher utilization was observed among Veterans 50 years of age and older compared to younger Veterans. Higher utilization was also observed among Veterans with increasing cumulative deployment time. Mental disorder diagnostic codes accounted for the greatest number of visits per Veteran. Conclusions: Veterans with mental health diagnoses may need a different level of care than other VHA users. Other service factors associated with utilization require further research to better understand the underlying relationship. Current observed results may be reflective of future expected utilization patterns and may assist in resource planning and research.
INTRODUCTION Since 2001, over 2.4 million service members have served or are serving in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF] and Operation New Dawn [OND]).1 Many of these individuals (Veterans) are eligible for care from the Veterans Health Administration (VHA) as a result of separation from the military or discharge from active duty status as reservists or guardsmen. Veterans have reported a wide range of injuries, infections, and long term health issues after returning from deployment. Further more, extended deployment length and repeated deployments have made it a challenge to attribute health issues to specific aspects of deployment for Veterans.2 Numerous studies have focused on specific injuries or ill nesses of the Veteran population who use VHA care.3-5 How ever, previous assessments of the Afghanistan and Iraq Veteran population have lacked a systematic overview of all injury and illness experiences captured by the VHA health care services. Such an assessment may help give perspective to the relative *Intellica Corporation, 209 West Poplar Street, San Antonio, TX 78212. /Lockheed Martin, 2700 Prosperity Avenue Suite 200, Fairfax, VA 22031. /Epidemiology Program, Post-Deployment Health Group. Office of Public Health. Veterans Health Administration, Department of Veterans Affairs, 1717 H Street, NW, Washington, DC 20006. doi: 10.7205/MILMED-D-14-00250
374
frequency of medical conditions among Veterans as well as the amount of care used for these different conditions. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them—comparing across demographic and service fac tors, as well as features of deployment history such as total time deployed and number of deployments.
METHODS D a ta S o u rc e
All data for this analysis were abstracted from the VHA Office of Public Health OEF/OIF/OND Health Surveillance System. This system contains a roster of Veterans who have served in OEF/OIF/OND and have subsequently separated from the military or were discharged from active duty status. This provides the list of eligible Veterans as well as demo graphic and service characteristics such as sex, service, com ponent, rank, and OEF/OIF/OND deployment history. The roster is provided to Office of Public Health by the Depart ment of Defense (DoD) Defense Manpower Data Center. VA medical encounter data were taken from the administrative health care records, which include both ambulatory and inpa tient visits at VHA health care facilities. Medical diagnostic coding is defined by the International Classification of
MILITARY MEDICINE, Vol. 180, April 2015
Health Care Utilization Behavior of Veterans TA B LE I.
Characteristics of Veterans Who Are Eligible and Percentage Using VHA Health Care, by Component, 2002 to 2010 Demographic and Service Characteristics of Eligible Veterans Regular Component
Characteristics Total Veterans Sex Male Female Age (Years)'
