Comparison of LIMBIC-CENC Research Findings Among Veterans With a Department of Veterans Affairs Positive Traumatic Brain Injury (TBI) Screen by Comprehensive TBI Evaluation Completion Status.

Objective: Those who served on active duty after September 11, 2001 (Post-9/11) are screened for deployment-related mild traumatic brain injury (mTBI) when initiating Veterans Health Administration (VHA) clinical services. Positive screeners are offered a referral to a Comprehensive TBI Evaluation (CTBIE) by a TBI specialist to further determine deployment-related mTBI history and access interdisciplinary care if indicated. This study examined whether Post-9/11 veterans who screened positive and also participated in a prospective longitudinal study (PLS) differed in characteristics and outcomes depending on their clinical VHA CTBIE completion status and mTBI positive (+) or negative (-) determinations (CTBIE = mTBI+, CTBIE = mTBI-, No CTBIE).

The relationship of resilience with prescription opioid use and misuse among people with spinal cord injury.

Purpose/objective: Spinal cord injury presents major long-term challenges, including the need to manage chronic pain and avoid overuse or misuse of prescription medication. Our purpose was to identify the extent to which resilience, bouncing back quickly from major challenges, is associated with prescription opioid use and misuse, controlling for depression.

Research Method/design: Follow-up data were collected from 918 individuals with spinal cord injury.

Association of Clinical TBI Severity and Military Factors With Veteran TBI Service-Connected Disability Ratings and Total Compensation: A Long-Term Impact of Military Brain Injury Consortium (LIMBIC) Study.

Objective: To understand how traumatic brain injury (TBI) clinical severity and military factors were associated with the likelihood of receiving a TBI service-connected disability (SCD) determination and monthly total SCD compensation among Veterans.

Setting: Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).

Participants: 1 319 590 veterans with a VBA SCD rating who entered the VHA between October 1, 2000, and September 24, 2019.

Racial/Ethnic and Geographic Differences in Traumatic Brain Injury (TBI) Service-Connected Disability Determination and Monthly Compensation Among Post-9/11 US Veterans.

Purpose: Veterans who incur a traumatic brain injury (TBI) during active duty service may be eligible to receive service-connected disability (SCD) compensation. This study examined potential racial/ethnic and geographic disparities in TBI SCD determination and overall monthly SCD compensation. Federal Tribal Land (FTL) was incorporated into existing VA geographic designations of urban, rural, highly rural, and US Territories (UST).

Department of Defense Military Treatment Facility and Community Care Costs After Traumatic Brain Injury in Service Members and Veterans Treated in Veterans Affairs Polytrauma Rehabilitation Centers: A VA TBI Model Systems Study.

Objective: To estimate cost models of military traumatic brain injury (TBI) that can provide evidence for future cost-effectiveness analyses highlighted as a gap in the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report on accelerating progress in TBI.

Setting: Military Treatment Facilities (MTFs) and community care facilities within the Military Health System (MHS).

Participants: 1,101 service members/veterans (SMV) diagnosed with a TBI and treated at a Veterans Administration (VA) Polytrauma Rehabilitation Center (PRC).

Detecting Mild Traumatic Brain Injury after Combat Deployment: Agreement Between Veterans Health Administration Clinical System and LIMBIC-CENC Research Protocol.

Identifying historical mild traumatic brain injury (TBI) is important for many clinical care reasons; however, diagnosing mild TBI is inherently challenging and utility of screening is unknown. This study compares a standardized research process to an established clinical process for screening and diagnosis of historical mild TBI during combat deployment in a military/Veteran cohort. Using validated instruments, the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study (PLS) screens for all potential concussive events (PCEs) and conducts structured concussion diagnostic interviews for each PCE.

Association of Limited Health Literacy With Clinical and Patient-Reported Outcomes in Individuals With Systemic Lupus Erythematosus.

Objective: Health literacy is an important social determinant of health, with limited health literacy associated with worse health outcomes. This study examined the associations between limited health literacy with patient-reported outcomes and disease activity/damage among 267 Black women with active systemic lupus erythematosus (SLE) enrolled in the Peer Approaches to Lupus Self-Management (PALS) program.

Methods: The three-item Chew Health Literacy Screening was used to dichotomize those reporting in the "limited" range on any item with outcomes compared via generalized linear models.

Relationships of self-reported opioid and benzodiazepine use with health-related quality of life among adults with spinal cord injury.

Background: There is limited understanding of the relationships between prescription opioid and benzodiazepine use and indices of health-related quality of life (HRQOL) among those with spinal cord injuries (SCI).

Objective: To identify the relationships between self-reported prescription opioid and benzodiazepine use and two indicators of HRQOL, number of days in poor physical health and poor mental health in the past 30 days among adults with SCI.

Methods: A cross-sectional cohort study of 918 adults with chronic (>1 year), traumatic SCI living in the Southeastern United States was conducted.

Relations Between Self-reported Prescription Hydrocodone, Oxycodone, and Tramadol Use and Unintentional Injuries Among Those With Spinal Cord Injury.

Objective: To identify the relations of 3 frequently used prescription opioids (hydrocodone, oxycodone, tramadol) with unintentional injuries, including fall-related and non-fall-related injuries among adults with chronic, traumatic spinal cord injury (SCI).

Design: Cross-sectional cohort study.

Setting: Community setting; Southeastern United States.

Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act.

Background: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorized a major expansion of purchased care in the community for Veterans experiencing access barriers in the Veterans Affairs (VA) health care system.

Objective: To estimate changes in primary care, mental health, and emergency/urgent care visits in the VA and community fiscal years (FY) 2018-2021 and differences between rural and urban clinics.

Design: A national, longitudinal study of VA clinics and outpatient utilization.

Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury.

Objective: To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation.

Setting: Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) clinical trial (NCT03033901) on an inpatient rehabilitation TBI cohort were used in this study.

Study Design: Decision tree analysis was used to determine the cost-effectiveness of approaches to diagnosing and treating sleep apnea.

Relationships of Self-reported Opioid Use and Misuse and Pain Severity With Probable Major Depression Among Participants With Spinal Cord Injury.

Objectives: To examine the relations of pain intensity, opioid use, and opioid misuse with depressive symptom severity and probable major depression (PMD) among participants with spinal cord injuries (SCI), controlling for demographic, injury, and socioeconomic characteristics.

Study Design: Cohort study.

Setting: Medical University in the Southeastern United States (US).

Self-Reported Prescription Opioid Use Among Participants with Chronic Spinal Cord Injury.

Background: Individuals with spinal cord injuries (SCI) experience high rates of prescription opioid use, yet there is limited data on frequency of opioid use and specific medications being taken.

Objectives: To examine the frequency of self-reported prescription opioid use among participants with SCI and the relationship with demographic, injury, and socioeconomic characteristics.

Methods: A cohort study of 918 adults with SCI of at least 1-year duration completed a self-report assessment (SRA) that indicated frequency of specific prescription opioid use based on the National Survey on Drug Use and Health (NSDUH).

Cannabis use disorder contributes to cognitive dysfunction in Veterans with traumatic brain injury.

Background: While emerging evidence supports a link between traumatic brain injury (TBI) and progressive cognitive dysfunction in Veterans, there is insufficient information on the impact of cannabis use disorder (CUD) on long-term cognitive disorders. This study aimed to examine the incidences of cognitive disorders in Veterans with TBI and CUD and to evaluate their relationship.

Methods: This retrospective cohort study used the US Department of Veterans Affairs and Department of Defense administrative data from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium Phenotype study.

The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic.

Background: The COVID-19 pandemic disrupted delivery of health care services worldwide. We examined the impact of the pandemic on clinics participating in the Veterans Affairs (VA) Clinical Resource Hub (CRH) program, rolled out nationally in October 2019, to improve access to care at under-resourced VA clinics or "spoke" sites through telehealth services delivered by regional "hub" sites.

Objective: To assess whether the CRH program was associated with increased access to primary care, we compared use of primary, emergency, and inpatient care at sites that adopted CRH for primary care (CRH-PC) with sites that did not adopt CRH-PC, pre-post pandemic onset.

Effect of Post-traumatic Amnesia Duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs Traumatic Brain Injury Model Systems Study.

Objective: To examine the association between severity of traumatic brain injury (TBI) as measured by duration of post-traumatic amnesia (PTA) and first year hospitalization costs for service members and veterans (SMVs) treated for TBI at Polytrauma Rehabilitation Centers (PRCs) within the Veterans Health Administration (VHA).

Design: Multivariable models of merged datasets from the VA TBI Model Systems (VA TBIMS) national database containing TBI clinical characterization including PTA with VHA hospital cost data.

Setting: Five VA PRCs.

Racial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury-Renal Failure in US Veterans and Associated Veterans Affairs Resource Costs, 2000-2020.

Unlabelled: Studies have identified disparities by race/ethnicity and geographic status among veterans with traumatic brain injury (TBI) and renal failure (RF). We examined the association of race/ethnicity and geographic status with RF onset in veterans with and without TBI, and the impact of disparities on Veterans Health Administration resource costs.

Methods: Demographics by TBI and RF status were assessed.

Alternative Structure Models of the Traumatic Brain Injury Rehabilitation Needs Survey: A Veterans Affairs TBI Model Systems Study.

Objective: To explore the factor structure of the Rehabilitation Needs Survey (RNS).

Design: Secondary analysis of observational cohort study who were 5-years post-traumatic brain injury (TBI).

Setting: Five Inpatient Rehabilitation Facilities.