coordination across the continuum of - amsus€¦ · audiology clinical coding document; collection...

UNCLASSIFIED

Coordination Across the Continuum of Care: The Defense Health Agency’s

Centers of Excellence ModelA

Defense Health Agency Research and Development (J9) Directorate

Centers of Excellence

“Medically Ready Force…Ready Medical Force” 1

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Disclaimer

The views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. Oral presentation for AMSUS, December, 2019.


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Disclosures

∎ This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS.

∎ Disclosure will be made when a product is discussed for an unapproved use

∎ AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

∎ Commercial Support was not received for this activity


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Objectives

∎ Define the roles of the Defense Health Agency’s Centers of Excellence

∎ Identify the capabilities and scope of services provided by the Centers of Excellence

∎ Describe at least three ways to access and collaborate with the Centers of Excellence


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Defense Health Agency Research and Development Centers of Excellence

∎Hearing Center of Excellence

∎ Psychological Health Center of Excellence

∎ Traumatic Brain Injury Center of Excellence

∎ Vision Center of Excellence


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National Defense Authorization Act

Centers of Excellence (CoE) in prevention, diagnosis, mitigation, treatment and rehabilitation:

∎ 2008

Traumatic brain injury

Post-traumatic stress disorder and other mental health conditions

Military eye injuries

∎ 2009

Hearing loss and auditory system injury


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Hearing Center of Excellence (HCE)

Col LaKeisha HenryUSAF, MC, FS

7“Medically Ready Force…Ready Medical Force”

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HCE Supports Hearing and Balance Health Across the Continuum of Care


HCE Working Groups/Collaborations

Best Practices/Clinical Practice Guidelines/Guidance/Policies

Research Coordination/Gap Analysis/Research Prioritization

Joint Hearing Loss and Auditory System Injury Registry/Data Analytics

Technology/Knowledge Product Development/Dissemination/Implementation

Education and Training

Advocacy and Strategic Communication/Outreach

HCE is a coordinated effort/platform to provide solutions focused on the continuum of auditory-vestibular system care

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HCE Capabilities

9

Prevention &

SurveillanceHearing Loss Prevention and Hearing Surveillance: Advocate for/develop best practices in hearing readiness/hearing loss prevention/hearing preservation across DoD and VA.

Information

Management

Information Management (IM): Provide support across HCE for initiatives with IM/IT requirements; establish IM system to capture and centralize data about hearing health, hearing impairment, and the auditory-vestibular system; assure quality data regarding the outcomes of hearing loss and auditory injury interventions captured in JHASIR. Train JHASIR clinical and research users.

Clinical SupportClinical Care, Rehabilitation, & Restoration: Determine and advocate for best practices/standards of care, and provide clinical skills education, training tools, and analyses to enable DoD/VA clinicians to improve access, quality, and timeliness of care.

Research

Coordination

Research Coordination: Identify military-relevant gaps between function and performance of auditory-vestibular health and injury, unify goals and objectives with other research organizations, industry, and international groups. Support knowledge product translation and technology transfer requirements.

Oversight &

Advocacy

DoD and VA Hearing/Balance Health Leadership, Oversight, & Advocacy: Provide vision and advocacy, overseeing all aspects of HCE's congressionally-directed mission to optimize operational performance, heighten medical readiness, and enhance quality of life through collaborative leadership/advocacy for hearing/balance initiatives. Ensure academic, industry, and international collaborations.

“Medically Ready Force…Ready Medical Force”

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Clinical Care Support

10

Training:

∎ The Military Vestibular Assessment and Rehabilitation (MVAR) course faculty conduct regional courses Providers from 4 specialties and sub-specialties trained to the national standard, improving patient outcomes and reducing external referrals for vestibular disorders, which can arise secondary to mild TBI.

∎ Continuing education webinars for VA and DoD audiologists, audiologists in the general community, as well as a variety of specialty and sub-specialty care providers from across the MHS, covering such topics as:

Tablet-Based Boothless Audiometry Development:

Ethics in clinical research; Overview of hearing conservation programs; Introduction into the management of tinnitus; Current standards/future directions for cochlear implants; Ototoxicity monitoring programs; Tools for outreach; Earlier identification of adult onset auditory disorders; Emerging research in accurate assessment of patient complaints of hearing impairment

Use in clinical audiology settings; Provides hearing conservation education delivery and knowledge assessments; Deploys validated clinical or custom research questionnaires; Delivers hearing readiness and wellness evaluations; Allows assessment of evaluated HPD productsProvides information management oversight; Pilot deployments underway

Source: http://www.tabsint.org/docs/references/references.html

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Operational Hearing Protection Strategies and Collaborative Working Groups

∎ Comprehensive Hearing Health Program (CHHP) – Educate, Protect, and Monitor

Brings standardization to the hearing loss prevention process; Increases individual knowledge, attitudes, beliefs, and behaviors (KABB) regarding hearing health and hearing loss prevention strategies

∎ Working Groups: DoD Hearing Conservation Working Group (DoD HCWG) works in collaboration with the Services to report annual hearing test results for the military (AD, Reserve, and National Guard) as a whole and broken down by each Service.

∎ Collaborative Hearing Health Education Network (CHHEN) is discussing ways to promote and increase awareness of hearing health and hearing loss prevention and opportunities for increased collaboration among the federal organizations.


Best practices: Develop and implement a standardized distributed

learning training program for DoD and VA Hearing Technicians to improve Veteran and Service member access to hearing health care. VA-DoD Joint Incentive Fund (JIF) program initiative.

Hearing Protection: Use of fit-check systems to assess hearing protection device (HPD) noise reduction; Photo by Army Sgt. Brendan Seiber, https://www.defense.gov/observe/photo-gallery/igphoto/2002168432/ The

appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.

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Hearing Protection Evaluated Product Lists –the Right Protection for Specific

Noise Hazards


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Combines clinical episodes of care from both DoD and VA audiograms, demographic, deployment, and theatre trauma and non-trauma data

All information is in computable fields to promote improvement, and continuity of care, analysis, research, and performance

Identifies and tracks personnel with hearing loss and auditory/vestibular injury via clinical diagnosis (ICD9/ICD10 codes in a watch list)

Supports readiness through monitoring

Provides outcomes data

Supports clinical providers with longitudinal data

Provides bidirectional data sharing capability between DoD and VA

Outlines, monitors, and reports on critical measures of program effectiveness

Enables research for the development of best practices

Joint Hearing Loss and Auditory System Injury Registry (JHASIR)


Source: iStockphoto.com

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JHASIR Data Sources and Computable Audiograms

14

*VA data sources are incorporated through DoD & VA Infrastructure for Clinical Intelligence (DAVINCI)


Source: HCE, 2018

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Portfolio Coordination:Gap Analysis & Content

Coordination

Translational Science Team

Regional Research Infrastructure: Laboratories

Regional Research Infrastructure: Medical Treatment Facilities

CAVRN & HCE / Branch Leadership

Biostatistics/Epidemiology

Clinical Research Grant Teams

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HCE Research Coordination Function


Source: HCE and Defense Health Agency, Research and Development Directorate

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Examples of HCE-Facilitated Research

Clinical Investigation of Hearing Injuries, Noise Exposures, and Cost Burden in Active Duty US Military Service Members (DEEBoHLS)

Hearing Health Education Delivery Using a Precision Preventive Medicine Approach (CHHP PMI)

DoD Hearing Loss Prevention Education: A Comprehensive Hearing Health Program (CHHP) Pilot Study

Characterization of Acute or Short-term-acquired Military Population Auditory Shifts (CHASMPAS)

Identifying Subgroups of Tinnitus Using Novel Resting fMRI Biomarkers and Cluster Analysis

Longitudinal Study of Hearing in the Military

Hearing Loss Risk Factor for Mishaps

Effects of Military Noise Exposure on Auditory Function in Service Members and Recently Discharged Veterans (“NOISE Study”)

Battlefield Acupuncture (BFA) as a Treatment Option for Chronic Tinnitus

Evaluating Vestibular Schwannomas and Asymmetric Sensorineural Hearing Loss (ASNHL) in the DoD


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Collaborative Auditory Vestibular Research Network (CAVRN)

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Annual meeting of approx. 100 attendees with strategy discussions, scientific presentations and posters, and as tours of local research facilities

Brings together stakeholders with auditory-vestibular research interest to discuss current and future research efforts across the DoD and VA enterprises, providing unique opportunities for collaboration

Fosters knowledge sharing and facilitates greater communication, coordination, awareness, synergy, progress, and transparency among community members

Promotes translation and best practices that influence auditory-vestibular readiness, care, and quality of life for warfighters and Veterans

Comprised of over 225 federal stakeholders

Develops and manages targeted working groups:

CAVRN


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CAVRN Groups:“PIHL”

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Pharmaceutical Interventions for Hearing Loss (PIHL) Group

> 200 DoD personnel (military, civilian, and contract support); other federal agency representatives (NIH, FDA, NIOSH/CDC); academic investigators; industry representatives; & non-profit or NGO representatives

Published 8 newsletters (HCE website, conference distribution)

67 papers published in special issues

Two additional special issues in progress (Frontiers, Journal of the Acoustical Society of America (JASA))

Support to USAMRDC Advanced Development Integrated Product Team for PI-Noise-Induced-HL acquisition activity and Hearing Restoration Research Program

Project outlined to create a centralized repository for ototoxicity and ototherapy evidence (discovery to clinical practice)


1. https://journals.lww.com/otology-neurotology/pages/collectiondetails.aspx?TopicalCollectionID=3 2. https://www.sciencedirect.com/journal/hearing-research/vol/349)3. https://www.frontiersin.org/research-topics/5317/cellular-mechanisms-of-ototoxicity

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Working Groups:Clinical Focus

18

∎ Tinnitus Working Group (WG): Support tinnitus CLINICAL PRACTICE by partnering with,

providing best practices and tools for, and training other healthcare providers i.e Progressive Tinnitus Management (PTM)

EDUCATE stakeholders about tinnitus management strategies

ADVOCATE for Service members and Veterans with tinnitus

Identify tinnitus care research gaps and explore opportunities for future RESEARCH

∎ Central Auditory Processing Disorders WG: Diagnostics

Rehabilitation

∎ Audiology & Vestibular Coding Standardization Audiology Clinical Coding Document; Collection method

for vestibular assessment & rehabilitation encounter data

Progressive Tinnitus Management (PTM) Progression. Henry J., et al., (20 Progressive Tinnitus ManagementClinical Handbook for Audiologists. VA RR&D NCRAR. VA Employee Education System. Avail at: https://hearing.health.mil/For-Providers/Progressive-Tinnitus-Management/PTM-Provider-Resources/PTM-Guides-and-Handbooks


https://hearing.health.mil/For-Providers/Progressive-Tinnitus-Management/PTM-Provider-Resources/PTM-Guides-and-Handbooks

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Psychological Health Center of Excellence (PHCoE)

CAPT Carrie KennedyMSC, USN


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PHCoE Capabilities


Prevention &

Outreach

Prevention & Outreach: Prevent mental illness, link beneficiaries with services, and support health promotion and risk reduction efforts including public mental health campaigns, stigma reduction efforts and transition support

Policy Analysis &

Development

Health Services & Population Research: Generate new findings/knowledge/judgments based on novel psychological health research; leverage existing or novel data sets

Implementation

Science

Implementation Science: Systematically apply methods of implementation science to study and promote the adoption of evidence-based practice change in pilot and/or enterprise settings

Special Projects

Surveillance & Medical Intelligence: Utilize administrative data to answer epidemiological questions and/or to characterize current trends within the Military Health System care delivery system

Surveillance &

Medical Intelligence

Special Projects: Address matters of significant importance to the mission of the Department of Defense that are direct requests from the Services and the Combatant Commands on topics relating to psychological health

Evidence Synthesis

& Gap Analysis

Health Services &

Population Research

Evidence Synthesis & Gap Analysis: Generate new findings/knowledge/judgments based on extant and in-progress psychological health research and identify gaps in research or practice

Policy Analysis & Development: Review, create and analyze pertinent psychological health policies

Source: PHCoE, 2019

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Prevention and Outreach: Real Warriors Campaign (realwarriors.net)

Multimedia public awareness campaign to reduce stigma, educate about PH and encourage help-seeking behavior to AD/RC, veterans, families, leaders and providers since 2008

Activities: Platform of print/digital resources including SM video profiles (2 of which

you can see on the jumbotron at Nationals home games) Outreach (Yellow Ribbon events, conferences, Twitter, Facebook, radio

media tours) Partner network (200+ service specific/military, government and non-

profit) Targeting areas with high need and low resources Will take requests to visit bases with needs to provide in person outreach;

will also co-brand materials for specific Services, bases or commands


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inTransition and Psychological Health Resource Center

Provide a mechanism for a warm handoff between systems of care and changes in providers during Service member’s (SM) transitions

Activities/services: inTransition coaching support across transitions and comprehensive care

coordination PHCoE Outreach Team: Yellow Ribbon events, site visits, conferences,

videos, individual commands upon request PHRC: available globally, 24/7 and 365 days a year to answer any PH

related questions, phone, e-mail or chat


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Implementation Science

∎ Primary Care Behavioral Health

IBHC and BHCF training, support and mentorship

Primary Care Clinical Community Clinical Pathways

Pain

Sleep

∎ Practice Based Implementation Network

Annual pilots

Support for knowledge translation agreements


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Evidence Synthesis and Gap Analysis

∎ Evidence Briefs

1-2 page digestible summaries of evidence on a PH diagnosis and specific treatment

∎ Systematic Reviews

Comprehensive and rigorous syntheses of available evidence, grounded in Cochrane, GRADE processes

∎ Rapid Reviews

Literature reviews of specific topics, usually requested by specific commands

∎ Research Gap Analysis


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Annual Research Gaps Annual Analysis & Report


Year 2016 2017 2018

Topic(final number of gaps identified)

• PTSD (11)

• Depression (6)

• Alcohol Use Disorder (9)

• Prescription Opioids (4)

• Novel Synthetic Drugs (5)

• Adjustment Disorder (11)

Example of high priority gap

• Conduct head-to-head comparative effectiveness trials of efficacious PTSD treatments that include better controls.

Examine the effects of leadership attitudes, group characteristics, and group identification factors on drinking in the military.

Develop and test the effectiveness of interventions that address reaction to the stressor in preventing adjustment disorders

Source: PHCoE, 2019

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Health Services and Population Research


DatasetsUnique in amount and variety of date combined. Beyond medical, employment, demographics, training, in-processing, deployment, discharge.

∎ DMDC (Defense Manpower Data Center)

∎ ARMS (Aviation Resource Management System)

∎ DTMS (Digital Training Management System)

∎ MODS (Medical Operational Data System)

∎ MDR (MHS Data Repository)

∎ TMDS (Theater Medical Data Store)

∎ DoDSER (Department of Defense Suicide Event Report)

∎ DAMIS (Drug and Alcohol Management Information System)

∎ PDCAPS (Physical Disability Case Processing System)

∎ BHDP (Behavioral Health Data Portal)

Longitudinal statistical analyses and modeling of combined health services and psychological health data from multiple sources:

Surveillance: “How prevalent?”Research: “What happened?”

Current Topics include: PH Trends and transitions, Longitudinal effects, Co-morbidities, Multi-morbidities, Deployment, Gender, Occupation, Suicide, Prescribing, Health service delivery

Source: PHCoE, 2019

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Some Current Studies

∎ PH Outcomes among Drone and Manned Aircraft (MA) Pilots

∎ PH Trends and Transitions among Active Duty Service Members

∎ PH Multimorbidity and Healthcare Utilization among Active Duty Military

∎ Combat Deployment, Psychological Health Diagnoses, and PH-Related Physical Health Conditions

∎ Unspecified Anxiety Disorder and Adjustment Disorder: Mental Health Services Utilization, Career Trajectory, and Military Discharge

∎ Effects of Combat and Gender on PTSD Status Transitions, 2002-2015

∎ Gambling Disorder and Problem Gambling in the DoD

∎ Impact of Occupation on Incidence of Psychiatric Conditions in the Time Approaching Separation from the Service

∎ Evaluating Measures of Combat Deployment to OEF/OIF/OND Using Population Level Data

∎ The Effects of Military Relevant Factors on Opioid Prescribing Practices in Army, Navy, Air Force, and Marine Service Members from 2002 – 2015


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Surveillance

∎DoDSER

∎ PCBH/IBHC Support

∎ Special Projects


0%

5%

10%

15%

20%

25%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Prev

alen

ce

Any Mental Health Condition by Military Branch (Bars) and Component (Dashes)

Air Force Army Marines Navy Active Duty Active G/R All Services All Compo

ICD-10 Implementation

All Components All Services

Source: PHCoE, 2019

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Defense and Veterans Brain Injury Center (DVBIC)

Traumatic Brain Injury Center of ExcellenceCAPT Scott Pyne

MC, USN


UNCLASSIFIED “Medically Ready Force…Ready Medical Force” 31

DVBIC Core Functions


DVBIC Partners:

ISC/NICoE

USU/CNRM

MRDC

Federal / academia

Industry

TBI community of interest

TBI Pathway of Care (PWoC) Manager

Focused clinical research on military relevant gaps

MHS enterprise provider training & policy recommendations

Standardized state-of-the-science clinical care recommendations and surveillance on emerging gaps

Source: https://theartjunctionwillardohio.wordpress.com/2013/10/13/don-moore-military-artist

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Research to Practice


Source: DVBIC, 2017


The DVBIC Branch Sections

Research Clinical investigations Congressionally-

mandated studies Epidemiological

research Statistical analysis Translation of research

Clinical Affairs Identification/ sharing

best practices Clinical guidelines and

recommendations (CRs)

TBI surveillance TBI outcomes

Education Educational tools TBI awareness &

training Product distribution/

dissemination Congressionally-

mandated Family Caregiver Resources

Regional Education Coordination (REC)

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DVBIC Capabilities


Across all capabilities we support congressional mandates and DHA initiatives including: Comprehensive Strategy for Warfighter Brain Health (CSWBH) and Quadruple Aim Performance Process (QPP)

Research Research: Conduct, support, implement, translate military relevant TBI research addressing DoD gaps. Enhance TBI research capabilities through 21 network sites across Military Health System.

Network SitesNetwork Sites: Disseminate findings to support development of evidence-based clinical and educational tools. Optimize DVBIC research operations, with assistance from the research support cell.

Portfolio

Management

Clinical Support

Surveillance

Outcome Analysis

Knowledge

Translation

Education

Outreach &

Dissemination

Portfolio Management: Align, manage and optimize research portfolio to address identified DVBIC gaps and priorities.

Clinical Support: Develop state-of-the-science clinical recommendations and clinical support products. Disseminate clinical recommendations to the combat operators.

Surveillance: Analyze TBI surveillance prevalence to inform the MHS on the impact of TBI.

Outcome Analysis: Evaluate TBI related outcomes to advise the MHS on the impact of TBI.

Knowledge Translation: Translate research findings into education products and training to educate the Force.

Education: Assist the Services to train the Medical Force to standardize and improve clinical practice. Increase Readiness by educating service members and veterans about TBI prevention, recognition and recovery

Outreach & Dissemination: Utilize regional education coordinator network to increase awareness of TBI across the care continuum to maximize access to care.

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Proposal pending addition to DVBIC

Portfolio

Pending Regulatory

IRB approved, no

enrollment

Active enrollment /

data collection

Actively enrolling subjects, close to enrollment goal

(≥ 90% goal)

Post-enrollment: Data analysis, manuscript preparation, product

development

Closed at site, ready to close out of DVBIC

portfolio

DVBIC Research Portfolio:74 Studies as of 24SEP19

35

Tota

l

4 14 5 27 4 23 1

*: Has reached at least 90% of enrollment goal

**: Includes NICOE and USU, collaborating sites associated with WRNMMC

Role of DVBIC in studyPrimary role: 59 studiesSecondary role: 15 studies

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Surveillance

35

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DVBIC Sites Strategically Located to Engage Providers and Patients


Camp Pendleton

NMC San Diego Fort Bliss

Fort Carson

Fort Campbell

WRNMMC/NICoE

Fort Belvoir

Camp Lejeune

Fort Bragg

Fort Drum

JBLM

JBER

Fort Hood

SAMMC

LandstuhlRMC

DVBIC VA locations not shown

- Richmond VA, VA- Minneapolis VA, MN- Tampa VA, TX- Palo Alto VA, TX- San Antonio VA, TX

DVBIC Site

Non-DVBIC Site

10,000

15,000

5,000

1,000

No. of TBI-Related Encounters

DVBIC Sites with an Intrepid Spirit Clinic USSOCOM/

MacDill AFB

Source: DVBIC, 2019

36

Based of FY18 TBI Surveillance Numbers


DVBIC Regional Education Coordinator Network Map

Fort Campbell

Source: DVBIC, 2019

SOCOM


DVBIC Resources

∎ DVBIC provides free TBI resources for:

Providers

Service Members

Veterans

Families

Caregivers

∎ These resources include educational materials, fact sheets, clinical recommendations and much more.

∎ Download and Order at https://dvbic.dcoe.mil

Source: DVBIC, 2019

https://dvbic.dcoe.mil/

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Provider Tools & Resources

∎ Clinical Recommendations

∎ Concussion Tools

MACE 2

Concussion Management Tool

PRA Clinical Recommendations Primary Care Manager

Rehabilitation Provider

∎ Virtual Tools and Trainings

Interactive Provider Trainings

Interactive Clinical Support Tool


Source: DVBIC, 2019


https://dvbic.dcoe.mil

Web-Based Resources

∎ MACE 2

∎ Cognitive Rehabilitation Clinical Recommendation

∎ Headache Virtual Suite

∎ CUBIST podcast



A Head for the Future

What is A Head for the Future?A Head for the Future is an initiative of the Defense and Veterans Brain Injury Center (DVBIC), launched in March 2015, to raise awareness of the signs, symptoms and treatment of traumatic brain injuries (TBIs) diagnosed in non-deployed settings. The campaign also educates service members, veterans and their families about the importance of preventing brain injuries here at home.

https://dvbic.dcoe.mil/aheadforthefuture


Source: A Head for the Future, 2019

https://dvbic.dcoe.mil/aheadforthefuture

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Vision Center of Excellence(VCE)

COL Mark ReynoldsMC, USA


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VCE Functions


MonitoringCharacterize the magnitude of vision-threatening battle injuries and disease/non-battle injuries (DNBI) and the respective impacts on readiness, retention, and post-service functioning. Identify key interventions or knowledge gaps in prevention, mitigation, and optimal treatment across the spectrum of care

Evaluation Evaluate the utilization and effectiveness of interventions on the incidence and outcomes of vision-threatening battle injuries and DNBI

Clinical Support

& Education

Produce and disseminate guidelines, standards of care and training to Service Members, leaders, and providers across the spectrum of care. Includes the Defense and Veterans Eye Injury and Vision Registry

ResearchIdentify military-relevant gaps requiring further research among the vision research community within the DoD and across agencies and academic institutions. Provide support and SME input to technology transfer efforts.

Policy

DevelopmentChampion policies related to vision and ocular health and readiness at the MHS level

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Ocular Injuries & Vision Threatening Conditions

Prehospital Care

Ocular Laser Exposure

Expeditionary Eye Care

Visual Function after TBI

Initial Care Role 1 Role 2 Role 3OCONUS

Role 4CONUS VA

Vision Care Services

Low Vision/Blind Rehabilitation

VCE Efforts across the Continuum

DNBI

Prevention


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Monitoring

∎ Surveillance and monitoring reports

Newly Injured Report for consultants

Medical Surveillance Monthly Report

∎ Coding guidance

Laser exposure/injury

Visual Dysfunction following TBI

Ocular Injuries


Source: https://health.mil/Military-Health-Topics/Combat-Support/Armed-Forces-Health-

Surveillance-Branch/Reports-and-Publications/Medical-Surveillance-Monthly-

Report

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Burden of Ocular and Vision Conditions 2018

Unclassified

Data from the Defense Medical Surveillance System, The Armed Forces Health Surveillance Branch, Defense Health Agency, Silver Spring, Maryland

[2018]


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Clinical Support – Guidelines

∎ Ocular Injuries and Vision-Threatening Conditions in PFC Clinical Practice Guidelines

∎ Evaluation and Disposition of Temporary Visual Interference and Ocular Injury after Suspected Ocular Laser Exposure

∎ Treatment of Ocular Trauma and Vision-threatening Conditions by Deployed Eye Care Providers

∎ Visual Dysfunction following TBI


Source: https://www.dailystar.co.uk/news/latest-news/493013/Laser-light-dangers-aeroplane-cockpit-pilot-blinded-police-warning

48

Photo by Petty Officer 2nd Class Timothy Black Fleet Combat Camera Pacific

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Clinical Support – Guidelines

∎ Clinical recommendations and support tools for TBI Eye care and TBI

Oculomotor Dysfunction and TBI

Visual Field Loss and TBI


https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations

Source: https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations/Eye-Care-and-TBI

November 2015 December 2016 April 2016

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Clinical Support – Registry

∎ Defense and Veterans Eye Injury and Vision Registry (DVEIVR)∎ Provides the Department of Defense (DoD) and the U.S Department

of Veterans Affairs (VA) vision care community with a health registry consisting of DoD and VA ocular clinical and related data

∎ Enable tracking of eye injuries of active duty Service Members to inform Coordination of care Longitudinal analysis

∎ Ongoing outcome analysis of diverse injury types to inform treatment recommendation


Source: https://visionregistry.informatics.afms.mil/Login.aspx?ReturnUrl=%2fDefault.aspx

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Clinical – Coordination of Care

∎ Care Coordination often challenging for ocular injuries

∎ Veterans Administration continuity essential for ongoing care of both Service Members and Veterans


Photo by Tech. Sgt. Robert Cloys 386th Air Expeditionary Wing Public Affairs

Photo by Patricia Beal, Womack Army Medical Center

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Education – Ocular Trauma Call

∎ Monthly teleconference directed at eye care providers across the DHA and Services

∎ Focuses on interventions and pathway through system of care

∎ Didactic presentation

∎ Provides CEU/CME/COPE credit through DHA J-7


Photograph by COL Mark ReynoldsPhoto by Petty Officer 2nd Class Timothy Black Fleet Combat Camera Pacific

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Education – Fact Sheets

∎ Caring for Patients Who are Blind or Visually Impaired (inpatient and outpatient care teams)

∎ Best practices for supporting blind and visually impaired patients in safely maintaining or regaining independence and quality of life during hospitalization and medical encounters

Interaction & orientation

Physical environment

Mobility assistance

∎ https://vce.health.mil/Resources/Products


Images taken from “Caring for Patients Who are Blind or Visually Impaired” VCE factsheets

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VCE - Research

∎ Visual Dysfunction after TBI

SME group Delphi project in conjunction with USUHS

∎ Vision Research Program (under CDMRP)

∎ Collaborative efforts with VA and academic institutions


Source: https://cdmrp.army.mil/vrp/pbks/VRP%20Highlights.pdf

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Questions?


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Contact Information

∎ HCE

https://hearing.health.mil/

E-mail: https://hearing.health.mil/Contact-Us

Phone: (210) 292-4100

∎ PHCoE

http://pdhealth.mil

E-mail: [email protected]

Facebook/Twitter: @PHCoE

Phone: (301)295-7692

∎ TBICoE/DVBIC


E-mail: [email protected]

Phone: (800) 870-9244

∎ VCE

https://vce.health.mil/

Email: https://vce.health.mil/[email protected]

Phone: (301)295-7628


https://hearing.health.mil/

http://pdhealth.mil/

http://pdhealth.mil/

mailto:[email protected]


mailto:[email protected]

https://vce.health.mil/

https://vce.health.mil/[email protected]

UNCLASSIFIED

“How to Earn CE If you would like to earn continuing education credit for this activity, please visit: http://amsus.cds.pesgce.com

Hurry, CE Certificates will only be available for 30 Days after this event!”


http://amsus.cds.pesgce.com/

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