Identifying and Validating Complex Comorbidity Clusters in OEF-OIF Veterans

项目总结/摘要 背景：一些研究描述了OEF-OIF退伍军人的身体或精神状况。是 然而，越来越清楚的是，许多退伍军人同时患有多种疾病，这增加了他们的健康状况。 治疗的复杂性。越来越多的关于OEF-OIF退伍军人的研究表明， 聚集在一起的共病模式VA HSR&D资助了创伤性脑损伤状态， 2008年5月的艺术会议（TBI SOTA）强调了我们现有知识的差距，并认识到 系统识别常见的合并症集群（以下简称合并症集群）， 需要了解长期的合并症模式，并预测这位退伍军人的医疗保健需求 特别是那些患有TBI的人。 目的： 目的1.在基线时确定OEF-OIF退伍军人中的合并症集群并描述模式 3年内的合并症轨迹（稳定vs.恶化）。 目标2.确定恶化与稳定轨迹的风险因素。 目标3.比较具有稳定合并症轨迹的个体与 那些表现出退化模式的人。 目标4.检查弹性应对，社会支持和心理健康措施的差异， 随机样本中每种合并症轨迹（稳定或恶化）的OEF-OIF VA患者 分层以表示每个初始共病聚类内的轨迹。 方法：这是一项流行的队列研究，将联合收割机数据从VA国家数据库（奥斯汀， 药房福利管理数据库、TBI筛查数据库、OEF-OIF数据库），主要数据 收集（调查）和国家VistA网络图表摘要，以实现我们的目标。本研究将 确定首次在VA护理中发现的个体的初始合并症群（FY 02 -08）。然后我们将使用潜在的 结合专家临床意见进行分类分析，以确定稳定性或 每个科摩罗集群内的恶化情况。我们将通过检查 与战斗有关的暴露和症状之间的关系，并通过比较 在每个共病群中具有稳定和恶化共病轨迹的个体。然后我们将 确定按初始共病群集和轨迹分层个体的随机样本， 利用测量和图表提取数据进行综合检查。使用改进的Dillman方法，我们 将从大约2,000名OEF-OIF VA患者中获得调查数据。调查将衡量心理健康 症状，应对策略，社会支持，关系的结构方面和就业状况。我们 将从部署前和部署后健康评估/再评估（PDHRA）中获取数据， 吸烟史、慢性病家族史和其他相关临床变量，通过VistA网络图表 抽象PDHRA将提供关于自我报告的健康，关系问题， 心理健康筛查工具。我们将使用描述性和双变量统计来检查 自我报告的弹性应对策略，社会支持，抑郁严重程度和 共患病轨迹，控制部署前和部署后初始自我报告的健康状况和部署 性问题将进行广义线性混合效应模型，以检查 共患病轨迹和弹性应对，社会支持和心理健康的措施。

PROJECT SUMMARY/ABSTRACT BACKGROUND: A number of studies describe physical or mental conditions among OEF-OIF veterans. It is becoming clear, however, that many veterans have multiple conditions concomitantly which increases the complexity of their treatment. The growing body of research on OEF-OIF veterans suggests that there are patterns of comorbid conditions that cluster together. The VA HSR&D funded a Traumatic Brain Injury State of the Art Conference (TBI SOTA) in May, 2008 that highlighted gaps in our current knowledge and recognized that a systematic identification of common clusters of comorbidities (hereafter comorbidity clusters) is needed to understand the long-term comorbidity patterns and project the health care needs of this veteran cohort, particularly those with TBI. OBJECTIVES: Objective 1. Identify comorbidity clusters among OEF-OIF veterans at baseline and describe patterns of comorbidity trajectories (stable vs. deterioration) over 3 years. Objective 2. Identify risk factors for trajectories of deterioration vs. stability. Objective 3. Compare VA health care utilization for individuals with stable comorbidity trajectories vs. those who exhibit patterns of deterioration. Objective 4. Examine differences in resilient coping, social support and measures of mental health for OEF-OIF VA patients in each comorbidity trajectory (stable or deterioration) in a random sample stratified to represent trajectories within each initial comorbidity cluster. METHODS: This is a prevalent cohort study that will combine data from VA national data repositories (Austin, Pharmacy Benefits Management database, TBI screening database, OEF-OIF database), primary data collection (survey) and national VistA Web chart abstraction to accomplish our objectives. This study will identify initial comorbidity clusters for individuals first seen in VA care (FY02-08). We will then use latent class analysis in conjunction with expert clinical opinion to identify comorbidity trajectories of stablility or deterioration within each comorbidity cluster. We will validate comorbidity clusters by examining the relationship between combat-related exposures and symptoms, and by comparing utilization among individuals with stable and deterioration comorbidity trajectories within each comorbidity cluster. We will then identify a random sample of individuals stratified by initial comorbidity cluster and trajectory to conduct more comprehensive examination using survey and chart abstraction data. Using a Modified Dillman approach, we will obtain survey data from approximately 2,000 OEF-OIF VA patients. Surveys will measure mental health symptoms, coping strategies, social support, structural aspects of relationships, and employment status. We will obtain data from pre- and post-deployment health assessments/ re-assessments (PDHRA) in addition to smoking history, family history of chronic disease, and other relevant clinical variables via VistA Web chart abstraction. The PDHRA will provide baseline information on self-reported health, relationship concerns, and mental health screening instruments. We will use descriptive and bivariate statistics to examine the relationships among self-reported resilient coping strategies, social support, depression severity and comorbidity trajectory, controlling for pre-and post-deployment initial self-reported health and deployment concerns. Generalized linear mixed effects modeling will be conducted to examine the associations between comorbidity trajectory and resilient coping, social support, and measures of mental health.