To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.

Background Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome (ACS). Although they may be elevated in patients presenting with Non-ACS conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods and Results Using the Veterans Affairs (VA) centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. Based on ICD-9 diagnostic codes, primary diagnoses were categorized as either ACS or Non-ACS conditions. Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a Non-ACS condition. Among that cohort, the most common diagnostic category involved the cardiovascular system and congestive heart failure (N=1661) and chronic coronary artery disease (N=1648) accounted for the major classifications. At one-year following hospital discharge, mortality in patients with a Non-ACS condition was 22.8% and was higher than the ACS cohort (Odds Ratio=1.39; 95%CI: 1.30–1.49). Despite the high prevalence of cardiovascular diseases in patients with a Non-ACS diagnosis, utilization of cardiac imaging within 90 days of hospitalization was low compared with ACS patients (Odds Ratio=0.25; 95%CI: 0.23–0.27). Conclusions Hospitalized patients with an elevated troponin level most often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets prior to hospital discharge.

Structured AbstractStudy design-We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs.Objective-To answer the following questions: 1) what diagnosis codes should be used to identify patients with neck and back pain in administrative data; 2) because the majority of complaints are characterized as non-specific or mechanical, what diagnosis codes should be used to identify patients with non-specific or mechanical problems in administrative data; and 3) what procedure and surgical codes should be used to identify patients who have undergone a surgical procedure on the neck or back.Summary of background data-Musculoskeletal neck and back pain are pervasive problems, associated with chronic pain, disability, and high rates of healthcare utilization. Administrative data have been widely used in formative research which has largely relied on the original work of Volinn, Cherkin, Deyo and Einstadter and the Back Pain Patient Outcomes Assessment Team first published in 1992. Significant variation in reports of incidence, prevalence, and morbidity associated with these problems may be due to non standard or conflicting methods to define study cohorts.Methods-A literature review produced seven methods for identifying neck and back pain in administrative data. These code lists were used to search VA data for patients with back and neck problems, and to further categorize each case by spinal segment involved, as non-specific/ mechanical and as surgical or not.Results-There is considerable overlap in most algorithms. However, gaps remain.Conclusions-Gaps are evident in existing methods and a new framework to identify patients with neck and back pain in administrative data is proposed.Correspondence to: Patricia L. Sinnott. U.S. Department of Veterans AffairsPublic Access Author manuscript Spine (Phila Pa 1976 Neck and back pain are highly prevalent problems and administrative data are commonly used to describe the incidence, prevalence, and geographic variation in practice for these conditions. [1][2][3][4][5][6][7][8][9][10][11] This work has largely relied on the methods published in 1992 by Volinn, Cherkin, Deyo and Einstadter and the Back Pain Patient Outcomes Assessment Team (BOAT) 12, 13, 14 that identified neck and back pain from ICD-9 15 codes and used hospitalization as a proxy for morbidity. 12-14, 16, 17 This original work has led to a broad range of research on neck and back problems using hospital, workers' compensation and Medicare data. [18][19][20][21][22][23][24][25] More recently, the International Society for Pharmacoeconomics and Outcomes Research 26 has adopted guidelines for conducting and reviewing research using retrospective administrative databases, but this guideline, while successful in creating an international standard for doing this type research, does not address the idiosyncracies of spine data. With these new guidelines and two decades of changes in medical practice 24...

One hundred thirty-eight Veterans Affairs mental health professionals completed a 128-item Posttraumatic Stress Disorder (PTSD) Practice Inventory that asked about their practices and attitudes related to disability assessment of PTSD. Results indicate strikingly wide variation in the attitudes and practices of clinicians conducting disability assessments for PTSD. In a high percentage of cases, these attitudes and practices conflict with best-practice guidelines. Specifically, 59% of clinicians reported rarely or never using testing, and only 17% indicated routinely using standardized clinical interviews. Less than 1% of respondents reported using functional assessment scales.