Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
Currently Skimming:
7 Use to Improve Clinical Care
7 Use to Improve Clinical Care
Pages 185-208
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 185... ...
or VA or in the community. The committee proposes three ways by which exposure registries such as AH&OBP Registry might contribute to clinical care: • By providing registry participants with access to basic and specialized longitudinal health care services designed to address their exposure concerns, including access to clinical subject-matter experts; • By providing clinicians with relevant information about the range and frequency of health conditions reported by registry participants, including uncommon health conditions such as constrictive bronchiolitis and interstitial lung disease, as well as relatively common conditions such as obstructive sleep apnea; and • By providing clinicians with information about a service member's or veteran's health and self-reported exposure history.
|
From page 186... ...
-- VA does not have special eligibility for veterans who were exposed to airborne hazards and open burn pits while serving in the Southwest Asia theater, although this may change with the passage of PL 117-168. Therefore, at present, if a veteran does not fit into one of the priority groups 1–6 for other reasons, he or she may not have access to VHA health care.
|
From page 187... ...
The Treatment Referral Program staff then spoke with 6,016 of those enrollees and used motivational interviewing techniques to reduce barriers to care and encourage respondents to enroll in the World Trade Center Health Program to access health care services; 2,425 registry enrollees applied to the health program. Staff assisted enrollees with the application process, helped them document their eligibility using self-reported exposure information from the survey, assisted registrants in making the clinical appointments, and conducted follow-up interviews.
|
From page 188... ...
TABLE 7-2 Percentage of Registry Participants Using VHA in the Year Prior to, the Year of, and the Year after Completing the Registry Questionnaire All Registry Participants Participants Not Participants Using Who Have a VHA Using VHA in the Year VHA in the Year Health Record Prior to Registry Prior to Registry Year of VHA Use (n = 208,854)
|
From page 189... ...
According to AHBPCE, of the registry participants who had received a health evaluation over 90% were enrolled in VHA care, and 99.6% 1 Several terms are used for the health evaluation portion of the registry that may be requested by veterans and service members who respond affirmatively to question 7.1.B. The questionnaire uses the term "free health evaluation" and "exam" as of October 26, 2021, but previously the terms "health concerns" and "health examination" (in VHA Directive 1307, August 19, 2019)
|
From page 190... ...
Using VHA in the Year Prior to, the Year of, and the Year after Completing the Registry Questionnaire and Receipt of a Health Evaluation Registry Participants without Registry Participants Registry Participants Health Evaluation but with Health Evaluation without Health Evaluation Expressed Interest Year of VHA Use (n = 18,389)
|
From page 191... ...
Service members may contact their local military medical facility to request a registry health evaluation. Based on the results of the health evaluation, the veteran may receive care for any health concerns or conditions at VA if he or she is eligible for care or may take a copy of the questionnaire responses and evaluation results to their community health provider for care.
|
From page 192... ...
VA OIG found that an "ineffective exam request process and inaccurate registry data resulted in most interested veterans not receiving Airborne Hazards and Open Burn Pit Registry exams" (VA OIG, 2022, p.
|
From page 193... ...
were conducted prior to the participant completing the registry questionnaire. The committee compared participants who have and have not received AH&OBP Registry health evaluations with regard to responses to two registry questions about discussing health concerns and last seeing a health care provider (Table 7-6)
|
From page 194... ...
diagnosis code) in the electronic health records for all registry participants who have used VHA since the registry began (as contained in the committee's dataset)
|
From page 195... ...
Another recommendation was that VA clarify the purpose of the health evaluation, consider referring to it as a "consultation" or "checkup," and emphasize that it is "recommended" rather than "optional." TABLE 7-8 Interest in Health Evaluations and Health Evaluations Received, by Number of Reported Health Conditions Number of Health All Participants Interest in a Health Evaluation Health Evaluation Received Conditions Reported (n = 278,645)
|
From page 196... ...
In August 2019, VHA issued Directive 1307: Airborne Hazards and Open Burn Pit Registry, which set forth clinical and administrative policies for the registry and established procedures for the health evaluation, including both clinical and administrative guidance for providers conducting the evaluation, and procedures for preparing the post-evaluation letters to veterans.2 The AH&OBP Registry health evaluation includes a physical examination and any associated laboratory tests, a discussion of health risks with a provider, and an objective recording of current health status (VA, 2014)
|
From page 197... ...
VA and DoD clinicians are able to access a veteran's or service member's electronic health records more easily than they can access the registry questionnaire. The committee recommends that the Airborne Hazards and Open Burn Pit Registry Clinical Template for registry health evaluations and the accompanying clinical guidance be modified to ensure that the VA clinician conducting the evaluation discusses the registry participant's military deployment and exposure histories with the participant and documents the information in the participant's electronic health record.
|
From page 198... ...
Furthermore, as noted earlier in the chapter, of the 50% of registry participants who had an interest in having an evaluation, less than 11% of them have actually received one. The Airborne Hazards and Open Burn Pit Registry Clinical Template, which is part of the electronic health record of veterans who are enrolled in VHA, helps ensure consistency in what is recorded by the clinician who conducts the registry health evaluation.
|
From page 199... ...
The Airborne Hazards and Burn Pits Center of Excellence In 2019 VA established AHBPCE, and charged it with improving the consistency and quality of the registry health evaluations of registry participants and with identifying registry participants with certain respiratory health conditions. The AHBPCE website states, "By studying Veterans with specific categories of health concerns drawn from the registry, the Airborne Hazards and Burn Pits Center of Excellence (AHBPCE)
|
From page 200... ...
PDCEN invites selected registry participants with certain health conditions or diagnoses to undergo an in-depth advanced comprehensive cardiopulmonary evaluation at one of six sites nationwide. These evaluations are distinct from the registry health evaluations described earlier and are standardized across sites (VA AHBPCE, 2021)
|
From page 201... ...
These providers, who receive continuing medical education from VA on the exposures of interest, may act as a trusted and valuable resource for communicating health risks to registry participants. Although the Gulf War Registry does not improve access to longitudinal health care, the comprehensive physical examination required for participation in the Gulf War Registry allows veterans and service members to share their experiences and concerns with a specially trained health care provider.
|
From page 202... ...
Therefore, although the committee is aware that clinicians at VA medical facilities can access a registry participant's responses to the questionnaire, it is unclear whether there is an abbreviated version that would, for example, not include responses on hobbies or childhood residence locations that are unlikely to be useful for the health evaluation. Such an abbreviated version would be very useful as a foundation for the discussion of military service and deployment history during the registry health evaluation.
|
From page 203... ...
. However, the committee finds that there are substantial issues with using the AH&OBP Registry to improve clinical care: For a veteran to receive the optional health evaluation, he or she must first complete the lengthy, online self-assessment questionnaire, which captures only a select set of health outcomes, and once the partici pant has expressed an interest in having a health evaluation, the responsibility for scheduling the evaluation with the VA environmental health coordinator rests entirely on the veteran, as does follow-up for any referrals the participant may receive.
|
From page 204... ...
The committee recommends that the Airborne Hazards and Open Burn Pit Registry Clinical Template for registry health evaluations and the accompanying clinical guidance be modified to ensure that the VA clinician conducting the evaluation discusses the registry participant's military deployment and exposure history with the participant and documents the information in the participant's electronic health record. Veterans who complete and submit the questionnaire can save and print out their responses and, for those who have received a health evaluation, receive a summary of the results of that evaluation.
|
From page 205... ...
Presentation to the Committee to Reassess the Depart ment of Veterans Affairs Airborne Hazards and Open Burn Pits Registry: New York City Department of Health and Mental Hygiene.
|
From page 206... ...
Eric Shuping, Director, Post-9/11 Era Environmental Health Program, Health Outcomes Military Exposures, VA to the Committee to Reassess the Department of Veterans Affairs Airborne Hazards and Open Burn Pits Registry. December 8.
|
From page 207... ...
2021. Airborne Hazards and Burn Pits Center of Excellence -- Airborne Hazards and Open Burn Pit Registry Efforts.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.