With the passage of the Post-9/11 GI Bill in 2008, more than 1.4 million service members and their families became eligible for higher education benefits, and veterans from the wars in Iraq and ...Afghanistan enrolled in colleges and universities in record numbers. The first wave of research about these new student veterans focused primarily on describing their characteristics and the transition from military service to civilian life and the college campus. This new edited collection presents findings from the second wave of research about student veterans, with a focus on data-driven evidence of academic success factors, including persistence, retention, degree completion, and employment after college. An invaluable resource for educators poised to enter the next phase of supporting military-connected college students.
Veterans are believed to be at high risk of suicide. However, research comparing suicide rates between veterans and nonveterans is limited, and even less is known regarding differences by history of ...Veterans Health Administration (VHA) service use. This study directly compared veteran and nonveteran suicide risk while for the first time differentiating veterans by VHA service use.
The cross-sectional study analyzed data from 173,969 adult suicide decedents from 23 states (2000-2010) included in the U.S. Department of Veterans Affairs suicide data archive. Annual standardized mortality ratios (SMRs) were computed for veterans compared with nonveterans and for veterans who used VHA services compared with veterans who did not, overall and separately for males and females.
After the analysis controlled for age and gender differences, the number of observed veteran suicides was approximately 20% higher than expected in 2000 (SMR=1.19, 95% confidence interval CI=1.10-1.28), and this increased to 60% higher by 2010 (SMR=1.63, CI=1.58-1.68). The elevated risk for female veterans (2010 SMR=5.89) was higher than that observed for male veterans (2010 SMR=1.54). Trends for non-VHA-utilizing veterans mirrored those of the veteran population as a whole, and the SMR for VHA-utilizing veterans declined. Since 2003, the number of suicides among VHA-utilizing veterans was less than expected when compared directly with the suicide rate among non-VHA-utilizing veterans.
Veterans are members of the community and, as such, are an important part of observed increases in U.S. suicide rates. Not all veterans are at equal or increasing risk of suicide, however. VHA-utilizing veterans appear to have declining absolute and relative suicide rates.
Claim Denied Roche, John D; John D Roche
2011, 2008, 2011-05-01
eBook
“The VA is not your loving Uncle Sam who opens his wallet and says, ‘Here you are, nephew—a $1,000 check per month for the rest of your life. That should take the pain out of your ...service injuries,’ ” writes John D. Roche. Far from it, he reveals. Though the Veterans Claims Assistance Act of 2000 requires Veterans Affairs to assist veterans in developing the foundation to support their claims, in reality if you rely on the VA to find and develop the evidence necessary to grant benefits then your claim is likely to be denied. Claim Denied! will help those veterans whose benefits have been denied correct the mistakes they made when they submitted their original claims. Appealing a VA decision is not an impossible feat, Roche says, but a veteran’s story must be presented in a well-organized and logical format, so any reviewing authority is able to understand the issues as they relate to the laws. This book explains in detail how to develop and present a successful appeal.
One of the most decorated groups that served in the Vietnam War, Chicanos fought and died in numbers well out of proportion to their percentage of the United States’ population. Yet despite this, ...their wartime experiences have never received much attention in either popular media or scholarly studies. To spotlight and preserve some of their stories, this book presents substantial interviews with Chicano Vietnam veterans and their families that explore the men’s experiences in combat, the war’s effects on the Chicano community, and the veterans’ postwar lives. Lea Ybarra groups the interviews topically to bring out different aspects of the Chicano vets’ experiences. In addition to discussing their involvement in and views on the Vietnam War, the veterans also reflect on their place in American society, American foreign policy, and the value of war. Veterans from several states and different socioeconomic classes give the book a broad-based perspective, which Ybarra frames with sociological material on the war and its impact on Chicanos.
Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this ...retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions.
We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among ...veterans with a GID diagnosis.
We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk.
GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population.
The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.
Highlights • This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans. • PTSD prevalence among OEF/OIF veterans was estimated at 23%. • Publication ...year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. • To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review which limited the generalizability of findings primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. • Additional research is needed with randomly selected, representative samples of veterans who have been administered PTSD diagnostic interviews.
Background
Congress, veterans’ groups, and the press have expressed concerns that access to care and quality of care in Department of Veterans Affairs (VA) settings are inferior to access and quality ...in non-VA settings.
Objective
To assess quality of outpatient and inpatient care in VA at the national level and facility level and to compare performance between VA and non-VA settings using recent performance measure data.
Main Measures
We assessed Patient Safety Indicators (PSIs), 30-day risk-standardized mortality and readmission measures, and ORYX measures for inpatient safety and effectiveness; Healthcare Effectiveness Data and Information Set (HEDIS®) measures for outpatient effectiveness; and Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS) and Survey of Healthcare Experiences of Patients (SHEP) survey measures for inpatient patient-centeredness. For inpatient care, we used propensity score matching to identify a subset of non-VA hospitals that were comparable to VA hospitals.
Key Results
VA hospitals performed on average the same as or significantly better than non-VA hospitals on all six measures of inpatient safety, all three inpatient mortality measures, and 12 inpatient effectiveness measures, but significantly worse than non-VA hospitals on three readmission measures and two effectiveness measures. The performance of VA facilities was significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures and for Medicare HMOs, it was significantly better for 14 measures and did not differ for two measures. High variation across VA facilities in the performance of some quality measures was observed, although variation was even greater among non-VA facilities.
Conclusions
The VA system performed similarly or better than the non-VA system on most of the nationally recognized measures of inpatient and outpatient care quality, but high variation across VA facilities indicates a need for targeted quality improvement.
•265,566 post-9/11 veterans with PTSD had >1 coded psychotherapy visit at the VA in 15 years.•While 22.8% initiated an evidence-based psychotherapy (EBP), only 9.1% completed treatment.•Veterans who ...completed EBP did so about 3 years after their initial mental health visit.•Factors associated with EBP completion included MST and combat/deployments.
Little is known about predictors of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), with most data coming from small cohort studies and post-hoc analyses of clinical trials. We examined patient and treatment factors associated with initiation and completion of EBP for PTSD in a large longitudinal cohort. We conducted a national, retrospective cohort study of all Iraq and Afghanistan War veterans who had a post-deployment PTSD diagnosis from 10/01–9/15 at a Veterans Health Administration facility and had at least one coded post-deployment psychotherapy visit. We examined utilization of PE and CPT (individual or group) during any 24-week period. We used ordered logistic, logistic, and Cox proportional hazards regressions to examine variables associated with EBP initiation, early termination, and completion, and time to completion. Over a 15-year period, of 265,566 veterans with PTSD, 22.8% initiated an EBP, and only 9.1% completed treatment. Completers did so about three years after their initial mental health visit. Factors positively associated with EBP completion included military sexual trauma, older age, race/ethnicity (i.e., African-American race for PE), combat, and multiple deployments. The VHA has become timelier in delivering EBP for PTSD, and several subgroups are more likely to complete EBP.
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