# Community Care Utilization among Post-9/11 Veterans with Traumatic Brain Injury

> **NIH VA I01** · PORTLAND VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Estimates suggest that 20% or more of Post-9/11 Veterans have experienced at least one
military-related traumatic brain injury (TBI); the majority are categorized as mild (mTBI). TBI of all levels of
severity, including mTBI, can lead to chronic physical, cognitive, and emotional symptoms that, for many,
interfere with daily functioning. It is also associated with comorbid diagnoses such as posttraumatic stress
disorder, depression, pain, dementia, and suicidal ideation. As such, early detection and coordinated treatment
are critical for preventing chronic dysfunction, disability, and early mortality among Veterans with TBI history.
The VA Polytrauma/TBI System of Care (PSC), through a regional, integrated structure, serves this function by
overseeing and providing screening, evaluation, education, and evidence-based treatment for those in need of
TBI-related care. The PSC will care for this substantial patient population for decades to come.
Since the 2014 passage of the Veterans Choice Act and, more recently, the VA MISSION Act, the VA has
been outsourcing larger amounts of healthcare to non-VA providers (“Community Care”). VA Community Care
may improve Veterans’ access to care; however, dual use of healthcare systems and providers can lead to
poor outcomes due to fragmentation of care. Preliminary work has suggested that higher proportions of
Veterans with TBI diagnoses, relative to those without TBI, are receiving VA Community Care services, and
that this may be leading to the receipt of therapies that are not recommended for patients with TBI.
Significance/Impact: This study will inform the development and implementation of strategies to enhance the
care received by Veterans with TBI who use VA Community Care services. This work will identify gaps in the
provision of evidence-based TBI care in a timely manner, as VA Community Care services continue to expand
under the new MISSION Act. Our results will help ensure that Veterans with TBI receive care that is
coordinated, interdisciplinary, and evidence-based, and that promotes their optimal health and functioning.
Innovation: This project will develop new knowledge about Community Care utilization and outcomes among
Veterans receiving care for TBI, a high-priority, clinically-complex patient population. It will be the first, to our
knowledge, to measure patient-reported health and functional outcomes among Veterans who receive
Community Care. Additionally, we will link to multiple VA and Department of Defense (DoD) databases to
objectively account for differences in characteristics between those who do and do not use Community Care.
Specific Aims: Our aims are to: (1) Describe utilization of VA Community Care (rates and types of; reliance
on) among Post-9/11 Veterans with TBI; (2) Estimate associations between Veterans’ reliance on Community
Care and their health and functional outcomes; and (3) Understand Veterans’ need for, perceptions of, and
experiences with VA Community Care.
...

## Key facts

- **NIH application ID:** 10070542
- **Project number:** 1I01HX003088-01A1
- **Recipient organization:** PORTLAND VA MEDICAL CENTER
- **Principal Investigator:** Kathleen F. Carlson
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-01-01 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10070542

## Citation

> US National Institutes of Health, RePORTER application 10070542, Community Care Utilization among Post-9/11 Veterans with Traumatic Brain Injury (1I01HX003088-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10070542. Licensed CC0.

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