Department of Veterans Affairs Collaboration With the Traumatic Brain Injury Model Systems Program

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THE DEPARTMENT OF VETERANS AFFAIRS (VA) has a long history of providing rehabilitation following traumatic brain injury (TBI) for veterans and service members. In 1992, VA formally designated 4 lead TBI rehabilitation centers located in Minneapolis, Minnesota, Richmond, Virginia, Palo Alto, California, and Tampa, Florida, to collaborate with the Department of Defense to stand up the congressionally mandated Defense and Veterans Head Injury Program (DVHIP).1 DVHIP, created largely in response to the first Persian Gulf War, was later renamed Defense and Veterans Brain Injury Center in 2002.
VA's lead TBI centers served as the cornerstone for acute inpatient TBI rehabilitation for service members injured during the Global War on Terror. These centers were redesignated as Polytrauma Rehabilitation Centers (PRCs) in 2005 (VA added San Antonio, Texas, as a fifth lead TBI center in 2011) as VA stood up the Polytrauma System of Care (PSC), recognizing the complex rehabilitation and ongoing healthcare needs of veterans injured during deployment. The PSC incorporates expanded programming to include transitional residential rehabilitation, comprehensive outpatient rehabilitation, and assistive technology laboratories, as well as the development of specialized protocols such as the Emerging Consciousness program.2
Collaboration with TBI subject matter experts to develop these state-of-the-art programs eventually lead to a formal agreement with the TBI Model Systems (TBIMS) program3 to allow VA to collect data similar to TBIMS sites and compare outcomes. The VA PRC TBIMS longitudinal database now has a significant veteran cohort that allows for direct comparison of rehabilitation outcomes in civilian facilities and VA.
The importance of the longitudinal database has come even more into focus during the past decade driven by the recognition of TBI as a chronic health condition with residual medical, functional, and psychosocial issues that should be addressed proactively and consistently. Following on the work of Masel and DeWitt4 and Malec et al,5 VA has been adjusting policy and programming to support veterans for their longer-term needs following TBI. Better understanding of the chronic effects of TBI, as well as defining the special needs for veterans with TBI, is essential for implementing the chronic care framework in the VA healthcare system. The focus on the longer-term wellness for veterans following TBI is advanced through implementation of findings from emerging research to improve services for veterans who are eligible for VA healthcare benefits for life.
Articles featured in this Journal of Head Trauma Rehabilitation supplement represent some of the first data analyses resulting from VA's participation in TBIMS and are of immediate benefit as VA considers policy development for the management of TBI as a chronic condition. For instance, results of the rehospitalization study by Tran et al and the analysis by Nakase-Richardson et al of the supervision needs of Veterans with TBI over time will help guide the recommendations for timely contact and intervention with veterans to prevent unnecessary hospitalizations. The article by Dillahunt-Aspillaga et al highlights the challenges faced by veterans seeking employment following TBI and has important implications for rehabilitation programming.
Studies published in this supplement impact not only healthcare delivery in VA but also other VA programs such as Caregiver Support. The study by Stevens et al on relationship stability explores factors that may help identify specific veterans at risk for a negative change in relationship status. This information is valuable for VA's Caregiver Support program to tailor policy to best support caregivers of veterans with TBI.
Participation in TBIMS allows VA to continue to define the unique needs of veterans following TBI and translate these findings into policy, essentially creating a model of continuous quality improvement for TBI rehabilitation within VA.

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