Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E Debakey VA Medical Center, Houston, TX 77030, USA.
Mil Med. 2024 Aug 30;189(9-10):e2153-e2162. doi: 10.1093/milmed/usae175.
The Veterans Health Administration (VHA) established the Airborne Hazards and Open Burn Pit Registry (AHOBPR) in 2014 to address exposure concerns for veterans who have served in military operations in Southwest Asia and Afghanistan. By 2021, over 236,086 veterans completed the online questionnaire and 60% requested an AHOBPR examination. Of those requesting an exam, only 12% had an exam recorded in their medical record. This article summarizes barriers and facilitators to delivering AHOBPR exams and shares lessons learned from facilities who have successfully implemented burn pit exams for veterans.
We (I.C.C and J.H.) constructed a key performance measure of AHOBPR examination (the ratio of examinations performed in facility over examinations assigned to a facility) to identify top performing facilities and then used stratified purposeful sampling among high-performing sites to recruit a diverse set of facilities for participation. We (P.V.C. and A.A.) recruited and interviewed key personnel at these facilities about their process of administering burn pit exams. Rapid qualitative methods were used to analyze interviews.
The ratio of exams performed to exams assigned ranged from 0.00 to 14.50 for the 129 facilities with available information. Twelve interviews were conducted with a total of 19 participants from 10 different facilities. We identified 3 barriers: Unclear responsibility, limited incentives and competing duties for personnel involved, and constrained resources. Facilitators included the presence of an internal facilitator, additional staff support, and coordination across a facility's departments to provide care.
Gaps across many VHA facilities to provide AHOBPR exams may be understood as stemming from organizational issues related to clear delegation of responsibility and staffing issues. VHA facilities that wish to increase AHOBPR exams for veterans may need additional administrative and medical staff.
退伍军人健康管理局（VHA）于 2014 年设立了航空危害和露天燃烧坑登记处（AHOBPR），以解决在西南亚和阿富汗军事行动中服役的退伍军人的暴露问题。到 2021 年，超过 236086 名退伍军人完成了在线问卷调查，其中 60%要求进行 AHOBPR 检查。在要求检查的人中，只有 12%在他们的医疗记录中记录了检查。本文总结了提供 AHOBPR 检查的障碍和促进因素，并分享了从成功为退伍军人实施燃烧坑检查的设施中吸取的经验教训。
我们（I.C.C 和 J.H.）构建了 AHOBPR 检查的关键绩效指标（在设施中进行的检查与分配给设施的检查之比），以确定表现最佳的设施，然后在表现良好的地点中使用分层有针对性的抽样，招募各种设施参与。我们（P.V.C. 和 A.A.）在这些设施中招募并采访了关键人员，了解他们进行燃烧坑检查的过程。快速定性方法用于分析访谈。
在有可用信息的 129 个设施中，进行的检查与分配的检查之比从 0.00 到 14.50 不等。对来自 10 个不同设施的 19 名参与者进行了 12 次访谈。我们确定了 3 个障碍：责任不明确，参与人员的激励和竞争职责有限，以及资源有限。促进因素包括内部促进者的存在，额外的人员支持，以及整个设施部门之间的协调以提供护理。
许多 VHA 设施在提供 AHOBPR 检查方面存在差距，这可能是由于与明确责任分工和人员配备问题相关的组织问题造成的。希望增加退伍军人 AHOBPR 检查的 VHA 设施可能需要额外的行政和医务人员。
