*South Texas Veterans Health Care System †Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio ‡Texas A&M Health Science Center, Bryan §Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center San Antonio, San Antonio ∥Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System, and Scott and White Healthcare System, Temple, TX ¶Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA #Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX.
Med Care. 2014 Feb;52(2):172-81. doi: 10.1097/MLR.0000000000000059.
A growing body of research on US Veterans from Afghanistan and Iraq [Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF)] has described the polytrauma clinical triad (PCT): traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain. Extant research has not explored comorbidity clusters in this population more broadly, particularly co-occurring chronic diseases.
The aim of the study was to identify comorbidity clusters among diagnoses of deployment-specific (TBI, PTSD, pain) and chronic (eg, hypertension, diabetes) conditions, and to examine the association of these clusters with health care utilization and adverse outcomes.
This was a retrospective cohort study.
The cohort comprised OEF/OIF Veterans who received care in the Veterans Health Administration in fiscal years (FY) 2008-2010.
We identified comorbidity using validated ICD-9-CM code-based algorithms and FY08-09 data, followed by which we applied latent class analysis to identify the most statistically distinct and clinically meaningful patterns of comorbidity. We examined the association of these clusters with process measures/outcomes using logistic regression to correlate medication use, acute health care utilization, and adverse outcomes in FY10.
In this cohort (N=191,797), we found 6 comorbidity clusters. Cluster 1: PCT+Chronic Disease (5%); Cluster 2: PCT (9%); Cluster 3: Mental Health+Substance Abuse (24%); Cluster 4: Sleep, Amputation, Chronic Disease (4%); Cluster 5: Pain, Moderate PTSD (6%); and Cluster 6: Relatively Healthy (53%). Subsequent health care utilization patterns and adverse events were consistent with disease patterns.
These comorbidity clusters extend beyond the PCT and may be used as a foundation to examine coordination/quality of care and outcomes for OEF/OIF Veterans with different patterns of comorbidity.
越来越多的研究关注来自阿富汗和伊拉克的美国退伍军人[持久自由行动和伊拉克自由行动，以及黎明行动（OEF/OIF）]，描述了创伤后三联征（PCT）：脑外伤（TBI）、创伤后应激障碍（PTSD）和疼痛。现有的研究尚未更广泛地探讨该人群中的合并症集群，特别是同时存在的慢性疾病。
本研究旨在确定与部署相关的诊断（TBI、PTSD、疼痛）和慢性疾病（如高血压、糖尿病）之间的合并症集群，并研究这些集群与医疗保健利用和不良后果的关联。
这是一项回顾性队列研究。
该队列包括在退伍军人健康管理局于 2008-2010 财年接受治疗的 OEF/OIF 退伍军人。
我们使用经过验证的 ICD-9-CM 代码为基础的算法和 2008-09 财年的数据确定了合并症，随后应用潜在类别分析确定最具统计学意义和临床意义的合并症模式。我们使用逻辑回归来检查这些集群与过程措施/结果的关联，以关联 2010 财年的药物使用、急性医疗保健利用和不良后果。
在该队列（N=191797）中，我们发现了 6 个合并症集群。集群 1：PCT+慢性疾病（5%）；集群 2：PCT（9%）；集群 3：心理健康+物质滥用（24%）；集群 4：睡眠、截肢、慢性疾病（4%）；集群 5：疼痛、中度 PTSD（6%）；集群 6：相对健康（53%）。随后的医疗保健利用模式和不良事件与疾病模式一致。
这些合并症集群超出了 PCT 的范围，可用于作为检查 OEF/OIF 退伍军人不同合并症模式的协调/医疗质量和结果的基础。
