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Postdeployment Polytrauma Diagnoses Among Soldiers and Veterans Using the Veterans Health Affairs Polytrauma System of Care and Receipt of Opioids, Nonpharmacologic, and Mental Health Treatments

Adams, Rachel Sayko, PhD, MPH; Larson, Mary Jo, PhD, MPA; Meerwijk, Esther L., PhD, MSN; Williams, Thomas V., PhD; Harris, Alex H. S., PhD, MS

Section Editor(s): Cornis-Pop, Micaela PhD; Scholten, Joel MD

The Journal of Head Trauma Rehabilitation: May/June 2019 - Volume 34 - Issue 3 - p 167–175
doi: 10.1097/HTR.0000000000000481
VA Polytrauma Transitional Rehabilitation Programs

Objectives: To determine the proportion of Army soldiers who utilized care in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC) within the postdeployment year and to describe prevalence of polytrauma diagnoses, and receipt of opioids, nonpharmacologic treatments (NPTs), and mental health treatments in the VHA during the year following first PSC utilization.

Setting: VHA's 4-tiered integrated PSC network of specialized rehabilitation services for military members and veterans with polytrauma.

Participants: Soldiers and veterans who used the PSC during the postdeployment year after an Afghanistan or Iraq deployment ending in fiscal years 2008-2011.

Design: Population-based cohort study.

Main Measures: Prevalence of polytrauma diagnoses (ie, traumatic brain injury [TBI], posttraumatic stress disorder [PTSD], and chronic pain [CP]), VHA utilization rates of opioid prescriptions, NPT, and specialty mental health treatment within 1 year of PSC utilization.

Results: In total, 2.6% of the sample (n = 16 590) used the PSC during the postdeployment year. Among PSC users, CP (76.5%), PTSD (53.1%), and TBI (48.6%) were common and more frequently found together than in isolation; 26.6% filled an opioid prescription, 35.5% received at least 1 NPT, and 83.8% received specialty mental health treatment in the VHA within 1 year of PSC utilization.

Conclusion: CP was the most common polytrauma condition among PSC users, highlighting the importance of incorporating interdisciplinary pain management approaches within the PSC, with an effort to reduce reliance on long-term opioid therapy and improve rehabilitation.

Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Drs Adams and Larson); Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Drs Meerwijk and Harris); and NORC at the University of Chicago, Bethesda, Maryland (Dr Williams).

Corresponding Author: Rachel Sayko Adams, PhD, MPH, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South St, Mailstop 035, Waltham, MA 02453 (

This study was funded by the National Center for Complementary and Integrative Health (R01 AT008404), with support to develop the study cohort from the National Institute on Drug Abuse (R01 DA030150) and the VA HSR&D Service (RCS14-232). The authors acknowledge Cheng Chen, MS, for Veterans Health Administration (VHA) programming support; Micaela Cornis-Pop, PhD, for review of their manuscript and guidance on interpreting VHA data related to the Polytrauma System of Care; Sharon Reif, PhD, for leadership developing analytic pain measures; AXIOM Resource Management for assisting with the specifications of complementary and integrative health modalities; Mark R. Bauer, MD, for clinical consultation; and Kennell and Associates, Inc, for compiling the data files used in these analyses. Chester Buckenmaier III, MD, of the Uniformed Services University is the Department of Defense (DoD) data sponsor. The Defense Health Agency's Privacy and Civil Liberties Office provided access to DoD data.

The opinions and assertions herein are those of the authors and do not necessarily reflect the official views of the DoD, Department of Veterans Affairs, or the National Institutes of Health.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.