The Quality of Mental Health Care for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom

*RAND Corporation, Santa Monica, CA †Altarum Institute, Alexandria, VA ‡Pilot Consulting, Las Vegas, NV §Department of Psychiatry and the Irving Institute for Clinical and Translational Research, Columbia University, New York, NY.
Medical care (Impact Factor: 2.94). 09/2012; 51(1). DOI: 10.1097/MLR.0b013e318270bb6c
Source: PubMed

ABSTRACT BACKGROUND:: Some Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans experience serious mental health (MH) problems. As OEF/OIF soldiers leave active military duty, their growing numbers pose a challenge to the Department of Veterans Affairs (VA) in delivering high-quality mental health/substance-use disorder (MH/SUD) care. OBJECTIVE:: To determine whether the quality of MH/SUD care provided by the VA differs by OEF/OIF veteran status. METHODS:: Veterans with selected MH/SUDs were identified from administrative records using diagnostic codes. OEF/OIF service was determined based on Defense Manpower Data Center separation files. Eleven processes of care and 7 utilization performance indicators were examined. Regression analyses were adjusted for veteran demographic and clinical characteristics to test for differences in care by OEF/OIF status. RESULTS:: Of the 836,699 veterans with selected diagnoses who received MH/SUD treatment in FY2007, 52,870 (6.3%) were OEF/OIF veterans. In unadjusted analyses, OEF/OIF veterans were more likely to receive evidence-based care processes captured by 6 of the 11 dichotomous performance indicators examined; however, among those receiving psychotherapy encounters, OEF/OIF veterans received significantly fewer visits (6.9 vs. 9.7, P<0.0001). In adjusted analyses, only postdischarge follow-up remained meaningfully higher for OEF/OIF veterans. CONCLUSIONS:: Efforts to maintain and/or increase OEF/OIF veteran participation in VA MH/SUD services should be informed by their characteristics, such as younger age and better physical health relative to other veterans.

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