Moore D Helen, Powell-Cope Gail, Belanger Heather G
Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL.
College of Nursing, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL.
Mil Med. 2018 Sep 1;183(9-10):e494-e501. doi: 10.1093/milmed/usy036.
In recognition of the incidence of traumatic brain injuries (TBIs) in the Iraq and Afghanistan conflicts, the Department of Veterans Affairs (VA) has, since 2007, examined returning U.S. service members for symptoms of TBI, a pre-condition for VA treatment of TBI. This study characterizes "Traumatic Brain Injury screen" service delivery, according to the barrier and facilitator viewpoints of those experiencing the delivery.
The purposeful sample comprised both Veteran patient and VA staff participants in the TBI screen program (n = 64), including patients (n = 14), health care providers (n = 38), and key informants (n = 12). Telephone interviews were conducted per standardized, semi-structured interview scripts; respondent narratives recorded and transcribed verbatim; natural emergence of key themes of discourse fostered through conventional content analysis; themes coded by meaning and meaning units organized by nature of influence on service delivery.
A wide variety of structural, administrative, and communications barriers impede TBI screen service delivery, and certain case management and other functions promote delivery.
The value of VA TBI screen service delivery is appreciated by its participants, but delivery is perceived as vulnerable to failure; the extent of such failure and short- and long-term effects on patient health and well-being outcomes is incompletely understood and merits investigation. Evaluating VA TBI screen service delivery under alternate modes of delivery, e.g., one-stop visits, expanded hours of delivery, shared appointment sessions, telehealth, and intensified case management is suggested.
鉴于伊拉克和阿富汗冲突中创伤性脑损伤（TBI）的发病率，自2007年以来，美国退伍军人事务部（VA）对回国的美国军人进行了TBI症状检查，这是VA治疗TBI的前提条件。本研究根据接受服务者的障碍和促进因素观点，对“创伤性脑损伤筛查”服务的提供情况进行了描述。
目的抽样包括TBI筛查项目中的退伍军人患者和VA工作人员参与者（n = 64），包括患者（n = 14）、医疗保健提供者（n = 38）和关键信息提供者（n = 12）。按照标准化的半结构化访谈脚本进行电话访谈；逐字记录并转录受访者的叙述；通过传统内容分析促进话语关键主题的自然浮现；根据意义对主题进行编码，并根据对服务提供的影响性质对意义单元进行组织。
各种各样的结构、行政和沟通障碍阻碍了TBI筛查服务的提供，而某些病例管理和其他功能则促进了服务的提供。
VA的TBI筛查服务提供的价值得到了参与者的认可，但该服务被认为容易失败；这种失败的程度以及对患者健康和福祉结果的短期和长期影响尚不完全清楚，值得进行调查。建议评估VA在替代服务提供模式下的TBI筛查服务提供情况，例如一站式就诊、延长服务时间、共享预约时段、远程医疗和强化病例管理。
