VAOIG Inspection of Cambridge, MD, Fort Howard, MD, Alexandria, VA, Greenbelt, MD, Wilmington, NC, and Jacksonville, NC.

Healthcare Inspection Community Based Outpatient Clinic Reviews Cambridge and Fort Howard, MD Alexandria, VA and Greenbelt, MD Wilmington and Jacksonville, NC 09/30/09. The VA Office of Inspector General reviewed six Community Based Outpatient Clinics (CBOCs) the week of August 10–14, 2009. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 5 were Cambridge and Fort Howard, MD; and Alexandria, VA and Greenbelt, MD; and, in VISN 6, Wilmington and Jacksonville, NC. The parent facilities of these CBOCs are VA Maryland Healthcare System, Washington DC VA Medical Center (VAMC), and Fayetteville VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, patient satisfaction, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISNs and facility management: Require that physician privileges are appropriate to the procedures performed. VAOIG

VAOIG Audit of the System Devleopment Life Cycle

Department of Veterans Affairs System Development Life Cycle Process 09/30/09. The Office of Inspector General conducted an audit to determine whether VA’s Office of Information and Technology (OI&T) effectively and efficiently used the System Devleopment Life Cycle (SDLC) process to manage VA’s major IT investments valued at approximately $3.4 billion. Although VA’s SDLC guide was adequate, OI&T needed to communicate and enforce the guidance to ensure major investments are effectively managed. Additionally, OI&T did not adequately monitor investments because they never fully centralized their management functions as they relate to the SDLC process. As a result, OI&T could not ensure investments were managed effectively and efficiently, leaving VA’s IT investment portfolio at risk. Given that OI&T is the steward of VA’s IT investments and responsible for managing a comprehensive IT investment portfolio, it is vital that immediate action be taken to implement management controls to ensure centralized oversight of VA’s IT investments. Otherwise, these management control deficiencies increase the risk that VA’s major IT investments could experience cost and schedule overruns which could ultimately lead to costly, unproductive, or failed programs and projects. The Assistant Secretary for Information and Technology agreed with our four recommendations and provided acceptable planned actions. Implementing these recommendations is expected to facilitate the implementation of management controls, ensure centralized management of VA’s IT investments, improve risk management and improve the overall governance of VA’s IT investments. We will follow up on their implementation until all proposed actions have been completed. VAOIG

VAOIG Inspection of Claim-Related Mail Handleing

Audit of VA Regional Office Claim-Related Mail Processing 09/30/09. The Office of Inspector General (OIG) conducted this audit to evaluate whether VA regional offices (VAROs) effectively managed mailroom operations and controlled the timely and accurate processing of claim-related mail. In fiscal year (FY) 2008, VBA processed about 20 million pieces of incoming mail and 13 million pieces of outgoing mail. Both the significant number of claim-related documents handled by VARO mailrooms and the potential effect on the processing of veterans claims that can occur if documents are inappropriately handled or destroyed make this a high-risk area for VBA. VAOIG

Integrated Treatment for Veterans With PTSD and Chronic Pain

Researchers develop an integrated treatment for veterans with chronic pain and posttraumatic stress 09/30/09. The wars in Iraq and Afghanistan have resulted in a growing number of soldiers evacuated to the United States for comprehensive care for physical and psychological trauma. Given the number of physical injuries often experienced by soldiers, it is not surprising that chronic pain is a frequent problem among returning soldiers from Operation Iraqi Freedom and Operation Enduring Freedom. Boston University Medical Center via Eurekalert!

Patients With Chronic Illnesses: Comparing the Health Care Systems

A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans. 09/29/09. We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems. Military Medicine via PubMed

PTSD and Poor Sleep

Is poor sleep in veterans a function of post-traumatic stress disorder? 09/9/09. Substantial research has demonstrated an association between post-traumatic stress disorder (PTSD) and quality of sleep, particularly in veteran populations. The exact nature of this relationship, however, is not clear. The possibility that poor sleep is a more general experience among veterans has not been explored to date, with most studies focusing only on veteran populations with PTSD. This pilot study aimed to explore whether sleep disturbance is common to veterans generally or simply those with PTSD. Data were collected from a community sample of 152 Australian Vietnam war veterans, 87 of whom did not meet criteria for PTSD. All those with PTSD and 90% of those without PTSD reported clinically significant sleep disturbance, indicating that serious sleep problems are common across the veteran population. Despite the limitations of this initial study, these results highlight the importance of ensuring that research into sleep disorders in veterans with PTSD pays attention to the potential etiological role of other military factors, including deployments. Military Medicine via PubMed

Civilian Social Workers: Serving the Veteran and Soldier

Civilian social work: serving the military and veteran populations. 09/29/09. This article discusses social work practice areas for civilian social workers who provide services to military service members,veterans, and their families. These practice areas include education, child welfare, domestic violence, mental health, health care, substance abuse, and criminal justice. The authors examine the impact of the contemporary military lifestyle and current military operations on service members and their families in the context of these practice areas, with the goal of compelling civilian social workers to acknowledge their responsibility to competently serve military and veteran clients. Social Work via PubMed

Case History: PTSD in a Female Veteran

Forever changed: posttraumatic stress disorder in female military veterans, a case report. 09/29/09. PURPOSE. This paper examines the experience of posttraumatic stress disorder (PTSD) in a female veteran of Operation Iraqi Freedom, including the barriers to treatment she encountered in an outpatient psychiatry clinic. DESIGN AND METHODS. Case report data were obtained through review of records and interviews with a veteran combat nurse diagnosed with chronic PTSD. CONCLUSIONS. Sex differences in PTSD are controversial, but PTSD in female military veterans is a significant problem. Gender may complicate diagnosis and treatment. This case report discusses these issues and invites further research. PRACTICE IMPLICATIONS. Advanced practice psychiatric nurses increasingly will see female veterans with PTSD in their practices. Perspectives in Psychiatric Care via PubMed

Intimate Relations and Veterans With PTSD

Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development. 09/29/09. Military operations in Iraq and Afghanistan have brought heightened awareness of military related PTSD, as well as the intimate relationship problems that accompany the disorder and can influence the course of veterans' trauma recovery. In this paper, we review recent research that documents the association between PTSD and intimate relationship problems in the most recent cohort of returning veterans and also synthesize research on prior eras of veterans and their intimate relationships in order to inform future research and treatment efforts with recently returned veterans and their families. We highlight the need for more theoretically-driven research that can account for the likely reciprocally causal association between PTSD and intimate relationship problems to advance understanding and inform prevention and treatment efforts for veterans and their families. Future research directions are offered to advance this field of study. Clinical Psychology Review via PubMed

VAOIG Audit of Veterans Benefits Administration’s Control of Veterans’ Claims Folders

Audit of Veterans Benefits Administration’s Control of Veterans’ Claims Folders 09/29/09. The Office of Inspector General (OIG) conducted this audit to evaluate the Veterans Benefits Administration’s (VBA) control of veterans’ claims folders. The objective for the audit was to determine if VBA had adequate procedures in place to locate veterans’ claims folders effectively.

VBA’s control of veterans’ claims folders, which contain personally identifiable information, was not effective because VBA managers did not track the number of lost or rebuilt folders, consistently enforce Control of Veterans Records System (COVERS) policies, and establish effective search procedures for missing claims folders. As of February 20, 2009, VBA had assigned about 4.2 million claims folders to regional offices for benefit claims processing and safeguarding. We projected the claims folders for an estimated 437,000 (10 percent) veterans were not at the location shown in COVERS. Claims folders for approximately 296,000 (7 percent) veterans were at locations different from that shown in COVERS (misplaced). Misplaced claims folders can cause unnecessary claim processing delays and increases the likelihood that folders will be lost. Claims folders for approximately 141,000 (3 percent) veterans were lost. Lost claims folders place additional burdens on the veterans and reduce the time regional office personnel have to spend processing claims. The Under Secretary for Benefits agreed with our findings and recommendations and made acceptable plans to implement appropriate actions. VAOIG