The American Legion Survey of Patient
Healthcare Experiences
Jeff Greenberg, Ph.D.
Data Recognition Corporation (DRC)
Institute for the Advancement of Military and Veteran Healthcare
Introduction
 Data Recognition Corporation (DRC) is a large, womanowned business which focuses on survey and healthcare
research, educational testing, and document production.
 Jeff Greenberg, Ph.D., Senior Director of Research and
Director of the DRC Institute for the Advancement of Military
and Veteran Healthcare, is a clinical psychologist who
completed his training in the Boston VA system, the National
Center for PTSD, Harvard University Medical School, and
Boston University Medical School.
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Introduction
 Dr. Greenberg is a researcher whose focus has been on
Military and Veteran mental healthcare, posttraumatic stress
disorder (PTSD), Traumatic Brain Injury (TBI), complex cooccurring disorders, depression, anxiety, substance abuse,
suicide, and healthcare quality and fidelity.
 Dr. Greenberg has published on PTSD and TBI and
depression amongst Military and Veteran populations. He
has served as a subject matter expert for Navy Medicine and
DoD Medicine, where he has focused and advised senior
leaders on mental health, clinical care, training, and policy.
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Overview of the Survey
 Collaboration between the American Legion and Data
Recognition Corporation (DRC)
 Exploratory research regarding
• Type of care patients report receiving for PTSD and TBI
• Patients’ perceptions of effectiveness of treatment
• Patients’ reports of access to a range of treatment
options, including Complementary and Alternative
Medicine (CAM)
 Quick turnaround study
 First step in long-range program to encourage treatment
options and fidelity to treatment protocols
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Need for the Research
 Limited information on types of treatment Veterans receive
 Limited research documenting fidelity to treatment models
 Limited knowledge about use of CAM
 Limited evidence of effectiveness of CAM
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Purpose of the Survey
 To obtain a snapshot of what treatments Veterans are
receiving and how they perceive them; and
 To obtain information to help guide more rigorous, in-depth
research to support the establishment of treatment models
and an eventual system of fidelity modeling.
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Methodology
 Web survey (opt-in)
 Content: demographics, treatment received, access to CAM,
perceived change in symptoms and reasons for treatment
termination
 Press releases and social marketing to recruit respondents
 30-day field period
 Analysis: frequencies and other descriptive statistics
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Key Findings
 Respondents reported common symptoms: Elevated Anger,
Pain, Sleep Problems, Anxiety, Depression and Irritability.
 For PTSD, individuals are receiving multiple therapy types
with fewer than a quarter of respondents receiving treatment
in conformity to DoD/VA evidence-based practice models of
care.
Key Findings (continued)
 For TBI, individuals are receiving a wide array of treatment
types.
 Medication appears to be the front line treatment reported by
respondents.
 A sizable proportion of respondents reported prescriptions of
up to 10 medications for PTSD/TBI across their treatment
experience.
Key Findings (continued)
 Broadly, respondents reported limited change following
treatment for PTSD and TBI:
• Following therapy, the majority of respondents reported
no change or worsening of symptoms;
• Following medication, a slight majority reported no
change or worsening of symptoms; and
• In general, approximately half of all respondents reported
no change or minimal improvement in symptoms.
Key Findings (continued)
 Nearly half of all respondents had discussed some type of
CAM-based treatment with their providers.
 Respondents reported numerous types of CAM treatments,
especially Meditation, Relaxation, and Stress Reduction.
Key Findings (continued)
 30 percent of respondents indicated they had terminated
treatment prior to completion.
 An array of rationales for treatment termination were
reported.
 In declining order, the rationales cited were: Lack of
Improvement, Side Effects, Dissatisfied with Provider, Solve
Problems on My Own, Time Burden or Distance to
Treatment, and Stigma
Survey Response
 14,734 views overall, with nearly 480 per day
 3,209 starts
 3,116 completions (nearly 22 percent of viewers became
completers)
 17-minute average completion time
 98 percent of completers in the United States
 74 percent used laptop,16 used percent smart phone,
10 percent used tablet
 97 percent Veteran, 3 percent spouse or other
Respondent Characteristics
Respondent Characteristics
Service-Connected Disability
Service-Connected Disability
Community
Location of Care Received
Care Received at a Private Facility
Frequency of Care for PTSD and/or TBI
Provider Type
Symptom Architecture and Severity
Intensity
9
8
7
6
5
4
3
2
1
0
Symptom Architecture and Severity
Severity
2720
2700
2680
2660
2640
2620
2600
2580
2560
Symptom Ratings
Level of Perceived Improvement
10 point Likert scale: 1= I got worse, 5 = No change, and 10 = I got better
Symptom Change Following Therapies
N = 2,309 (41% report improvement and 59% report no change or worsened)
Symptom Change Following Medication
N = 2,212 (48% report improvement and 52% report no change or
worsened)
PTSD Treatment Type
TBI Treatment Type
Prescriptions for PTSD and TBI
Discussed CAM Treatments with Provider
CAM Treatment Type for PTSD
CAM Treatment Type for TBI
Terminated Treatment Prior to Completion
Reason Given for Terminating Treatment
Recommendations
 To establish a knowledge base on the care of Veterans with PTSD
and TBI, a multi-step program of research is needed over a period
of years:
• Establishment of baseline date, building on information
gathered here, but probing more deeply and capturing data
suitable for correlations and statistical modeling;
• Surveys to track progress over time;
• Funding of demonstration programs to test effectiveness of
alternative treatments and to generate best practices and
models of care as well as update practice guidelines with new
findings; and
• Establishment of system for monitoring and evaluating fidelity
of care.
Recommendations (continued)
 Simultaneously, a second track of research and development is
needed to ensure the availability of a trained work force prepared
to treat PTSD and TBI. That will entail steps parallel to the
development of models of care:
• Ancillary research on professional development related to
treatment of PTSD and TBI;
• Development of professional standards and collaboration with
schools to build curricula that support standards of care;
• Establishment of a National Advisory Group to plan the multistep research program; and
• Regular tracking surveys.
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Next Steps
 Establish a National Advisory Group to plan the multi-step research
program.
 Refine survey design in preparation for collection of baseline data
and tracking surveys.
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Timeline
 FY 2015: Establish National Advisory Group.
 FY 2016: Begin Research:
• Conduct Research to Establish Baseline on Treatment of PTSD
and TBI; and
• Conduct Research on Professional Development.
 FY 2017:
• Announce 3-Year Demonstration Program; and
• Establish Work Group to Collaborate with Professional
Schools.
 FY 2018: First Tracking Survey.
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Timeline (continued)
 FY 2020: Second Tracking Survey.
 FY 2021: Establish Practice Guidelines/Models of Care.
 FY 2022: Establish Monitoring and Evaluation System to Measure
Fidelity to Models of Care, Examining both Treatment Provided and
Professional Development of Health Care Providers.
 FY 2022 and Beyond:
• Continue Bi-annual Tracking Surveys/Integrate with Monitoring.
• Process for Ongoing Integration of Tested Innovations.
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Thank You
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Backup Slides
Anger
Pain
Sleep Problems
Anxiety
Depression
Irritability
Tour of Duty
Telehealth
Travel Time
Treatment Mode