Evaluation of the Veterans Health Administration Traumatic Brain Injury Screening Program in the Upper Midwest

Objective: To evaluate the Veterans Health Administration's traumatic brain injury (TBI) screening program in terms of predictors of screening and positive-screen follow-up. Design: Retrospective administrative data study. Multiple logistic regression analyses were used to estimate the odds of TBI screening at a given appointment and among those screening positive, follow-up in a TBI/polytrauma specialty clinic. Participants: A total of 15 973 Iraq and Afghanistan war veterans treated at a Veterans Affairs medical center in the upper Midwest during the first 18 months of the TBI screening program. Results: Almost 90% of Iraq and Afghanistan veteran patients were offered TBI screening and 17% screened positive. Screening rates increased over time and varied by facility. Appointment type predicted screening with increased likelihood of screening during primary care and TBI/polytrauma clinic appointments. Younger, male, and army veterans without psychiatric diagnoses were more likely to be screened. Fifty-two percent of positive TBI screens had subsequent appointments in a TBI/polytrauma specialty clinic during the study period. Rates of follow-up in the clinic increased over time and varied by facility and patient characteristics. Conclusions: Within the upper Midwest, Veterans Health Administration has had greater success implementing TBI screening than ensuring follow-up of positive screens in a specialty clinic. Research is needed on barriers to follow-up of positive screens and the outcomes of TBI screening and subsequent specialty care.