Large national study tracks veterans’ health, highlights areas of unmet needs

• Novel data describes use of instrument that encourages vets to report on their health using a brief survey
• PROMIS self-reported outcomes matched physician diagnoses documented in medical records
• This tool may serve as a motivator for some veterans who are hesitant to seek medical care
• Findings provide fuller picture of national health, allow health professionals to see how everyone, including veterans, is doing

CHICAGO — For the first time, a large national population of United States veterans used the same standardized tool that the general population uses for tracking health.

More than 3,000 veterans from across the country used the tool to self-report their health in the study led by a researcher from Northwestern Medicine and the U.S. Department of Veterans Affairs. Findings showed that veterans scored worse in several areas, including feeling more anxiety, depression, fatigue, sleep disturbance and pain compared to people in the general population.

These self-reported outcomes were valid because they matched physician diagnoses documented in medical records, the study found.

The study’s scientists believe patient self-reporting will be a successful way to track the health of veterans, who may be hesitant to seek medical care.

The self-reporting tool – a survey called PROMIS-29 – is commonly used in the general population but not widely or systematically offered to veterans. The scientists mailed the survey to veterans for this study, which is the first to report PROMIS-29’s use in a large national cohort of veterans.

“These are our nation’s veterans. They served our country, and they deserve access to things made available to everyone,” said lead author Sherri LaVela, a research associate professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine and a department of veterans affairs scientist. “The PROMIS instrument is being used more and more for health care, and we hope to see it integrated into veteran care as well.”

The instrument used in the study may be a useful tool for health care providers to assess veteran patient’s physical and mental health, as indicated by the positive associations between scores and clinical documentation which suggests clinical validity for targeted measures, LaVela said.

The study was published last week in the Journal of General Internal Medicine.

The VA serves more than 8.3 million veterans in the U.S. annually.

“Seeing how veterans fare relative to population norms is important because it gives us a fuller picture of their health and allows us a cursory glance at how they are doing in general,” LaVela said. “Estimates like this are important because they provide normal ranges for health measures across cohorts.

“Veterans have enhanced options of seeking care outside the VA, which makes it crucial to have an accurate measurement of health status and symptoms among population-based samples. Being able to simply, yet effectively, collect these data will identify unmet needs in which to intervene.”

Patients using PROMIS-29 answered a short series of questions about their health and quality of life. The survey is scored to indicate if they are experiencing disturbed sleep, anxiety, depression or pain, for instance. Given the responses, the patient and their health care team can follow up and schedule a doctor’s appointment.

“If a veteran has poor scores, we want to get them in and take a look,” LaVela said.

Veterans in the study also scored lower for physical function than civilians and lower for satisfaction with social role, such as being satisfied with their ability to work, do regular personal and household responsibilities, and perform daily routines.

Patient-reported data can be used to inform health care providers about symptoms, perceived state of health and are especially important to understand patient experiences among people with chronic diseases.

The ability to quickly and easily identify health disparities in veterans is important because it can prompt health care providers to intervene. For example, the study found that relative to general population norms, veterans reported worse scores for pain interference. The VA has been integrating innovative, patient-centric approaches ways into treatment options. Using pain as an example, the VA has a stepped-care pain management approach that can be used for intervention, and recently the VA implemented mindfulness types of interventions to help veterans with pain, post-traumatic stress disorder, and other conditions that may afflict veterans, LaVela said.

Former Marine Dustin Lange said seeing how a veteran’s health stacks up against the general population can serve as much-needed motivation for a veteran to go see the doctor.

“A lot of times, veterans might be hesitant to go to the hospital or not get proper checkups,” said Lange, a U.S. Veteran who spent eight years in the Marines and is now the associate director of the Chez Center for Wounded Veterans in Higher Education at University of Illinois, Urbana-Champaign.

Lange has taken the PROMIS-29 survey, though not for this study. His score indicated some disturbances in his sleep, which prompted him to schedule a doctor’s appointment. His clinical checkup validated his PROMIS-29 results. Lange said he hopes PROMIS-29 becomes more widely available for veterans, because he thinks it could motivate veterans to see a doctor.

“As a vet, you’re able to see, ‘Am I having similar problems to the general population? Do I have higher sleep or pain problems?” Lange said. “Seeing that difference from the general population could prompt a vet to visit the VA and get help.”

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David Cella, chair of the department of medical social sciences at Feinberg, was the study’s senior author. Bella Etingen and Scott Miskevics from the Department of Veterans Affairs were co-authors.

Funding for the study was provided to LaVela by Veterans Health Administration, Office of Research and Development, Health Services Research and Development, Office of Patient-Centered Care and Cultural Transformation.