Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
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10 Future Use of the AH&OBP Registry
10 Future Use of the AH&OBP Registry
Pages 239-258
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From page 239... ...
, • to perform population health surveillance (Chapter 6) , • to improve clinical care (Chapter 7)
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From page 240... ...
, the Millennium Cohort Study, the Gulf War Registry, and various epidemiologic studies, could contribute to informing etiologic research, as summarized below. ILER One of the goals of ILER is to provide researchers with greater access to hazard and exposure information that can facilitate the identification of research cohorts with verified location information and health outcomes.
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From page 241... ...
As new capabilities are added and as validated exposure and health information becomes available, ILER could become a complementary tool in VA and DoD efforts to understand the health effects of military exposures, but at this time it should not be viewed as an alternative resource for conducting etiologic research to determine causal associations between exposures encountered during military service and health outcomes. Millennium Cohort Study The Millennium Cohort Study is an ongoing epidemiologic study of active-duty service members intended to assess the health of participants after they separate from the military.
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From page 242... ...
The committee finds that the AH&OBP Registry does not satisfy all four of the criteria necessary to conduct population health surveillance for service members and veterans potentially exposed to burn pits or other airborne hazards in the Southwest Asia theater. Furthermore, given its fundamental design, the committee concludes that refinements or improvements will not allow the AH&OBP Registry to serve as a population health surveillance system.
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From page 243... ...
Several features of ILER that make it unsuitable for conducting etiologic research on the health effects of burn pits and other airborne hazards exposures at present were described in detail in Chapter 5, and several of those factors continue to be relevant when considering ILER's use for population health surveillance. For example, its available location information does not cover 1990–1991 Gulf War or Peacetime era deployments.
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From page 244... ...
The impact of these information gaps will depend on the specific exposure of interest, but may be particularly problematic for burn pit exposures. As such, ILER is not and should not be looked to or promoted as a population health surveillance system for service members and veterans exposed to burn pits and airborne hazards before 2006.
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VA has worked to standardize the health evaluation by implementing the AHOBPR Clinical Template with accompanying guidance on its use; the template is available electronically to VHA clinicians. 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 them and documents the information in the participant's electronic health record.
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From page 246... ...
Although no data were available to the committee to describe trends in VA health care enrollment following registry enrollment or receiving the health evaluation, it appears that participating in the registry and, to a lesser extent, receiving the evaluation may increase subsequent VHA use, although the committee acknowledges that several other factors may also affect VHA use subsequent to AH&OBP Registry participation. Thus, joining the AH&OBP Registry might be an incentive for eligible registry participants to seek care at VHA if already enrolled and to join VHA if they are eligible and have not already done so.
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From page 247... ...
Finally, VA has informed registry participants that the information they provided helped inform VA's determination of presumptive service connections between deployment exposures to fine particulate matter in the Southwest Asia theater and asthma, rhinitis, and sinusitis. AH&OBP Registry data on respiratory conditions may have affirmed, or at least did not contradict, the presumptive connections in question.
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From page 248... ...
The VA public health webpages contain a variety of information about specific deployment exposures, including to burn pits and other airborne hazards, but what, if any, information has been derived from registry data is not clear. Nor does it appear that any such information is sent directly to registry participants on a regular basis, either electronically or by the U.S.
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From page 249... ...
Communication channels other than the questionnaire that might be used include hardcopy mailed materials, virtual meetings, webinars, workshops, town halls, and a comment field on the registry's website. Although the AH&OBP Registry cannot be used to perform etiologic research, cannot be used to conduct population health surveillance or monitoring, does not inform VA policies or processes, and has only a tenuous ability to improve clinical care, there are other functions that the registry might be better suited to accomplish, including documenting the experience of participants and creating a roster of individuals who might benefit from specific communications or activities.
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From page 250... ...
This involved assessing both what it has contributed to achieving its stated purposes since its national launch in June 2014 and, more importantly, whether sustained data collection and analysis will make future contributions. Maintaining the AH&OBP Registry in its current state means that new participants will continue to enroll, so a key determinant is whether the addition of these future enrollees will be helpful in addressing the broader concerns 2 Including over $1 million a year in information technology, over $3.3 million a year in health evaluations and associated tests, and over $1 million in contacts for communication and outreach, as well as operational and development costs not provided to the committee (see Chapter 3)
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From page 251... ...
Therefore, the committee concludes that the stated registry purposes of "research about potential health effects of airborne hazards exposures" (VA, 2021c) and conducting population health surveillance are unattainable, that data collection to meet these purposes is not helpful, and that efforts to address these important functions could be pursued in other, more effective ways.
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From page 252... ...
The effort and resources (including budgetary resources) devoted to maintaining the AH&OBP Registry in its current form would be more usefully directed toward using and refining alternative mechanisms for etiologic research and population health surveillance, with sufficient resources remaining to support a greatly streamlined, time- and cost-efficient mechanism for generating a roster of individuals who are interested in or concerned about the health effects of airborne hazards exposures.
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From page 253... ...
These guiding functions should not include etiologic research or population health surveillance. Therefore, the committee recommends that the current self-assessment questionnaire be replaced with one that is shorter, more efficient, user friendly, and limited in scope to collect only information that can be used to support communication or health care.
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From page 254... ...
The few changes made to the registry questionnaire since the initial assessment -- revised questions regarding the desire for a health evaluation and contact information -- have not been pilot tested with potential or current registry participants. Questions on deployment exposures and health outcomes, including asking about sinusitis and rhinitis, which are now service connected, have not changed since the registry began.
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From page 255... ...
and in burn pit and airborne hazards research, diagnosis, and treatment in general; and • what alternative form of surveillance and identification of research candidates would need to be identified if the AH&OBP Registry was closed? Using Alternate Systems of Records and Data Sources for Airborne Hazards Research To address the first two bullets above and throughout this report, the committee has explored whether alternate data sources or approaches might replace or supplement the AH&OBP Registry for etiologic research; population health surveillance; improving clinical care; informing VA processes and policies; and communicating with veterans, service members, health care providers, and other stakeholders about the exposure to airborne hazards and burn pits and possible health effects.
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From page 256... ...
This does not include the additional time of the more than 30,000 participants who opted to receive the AH&OBP Registry health evaluation between June 2014 and February 2022, nor the time they spent contacting and scheduling the health evaluation, traveling to the VA facility for evaluation, waiting to be seen, having the evaluation along with any associated laboratory tests, and discussing or following up on results with primary care providers. Therefore, if the data are not able to be used for the intended functions (etiologic research and population health surveillance)
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From page 257... ...
2021a. Response to the Committee to Reassess the Department of Veterans Affairs Airborne Hazards and Open Burn Pits Registry information and data request.
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