A Shared Definition of High-Quality Care Can Help Veterans Combat Invisible Wounds

by Carrie M. Farmer, Lu Dong: For Entire Post, Go Here…

Components of High-Quality Care for Veterans with PTSD and TBI

Veteran-Centered Care

Similar to the traditional health care model of patient-centered care, the goal of veteran-centered care is to provide effective and timely treatment that addresses the unique needs, values, and preferences of veterans. Providing veteran-centered care requires health care providers to be familiar with veteran culture and identity, the implications of military service, and the needs of diverse populations of veterans—a concept known as cultural competence.

Veteran-centered care requires ongoing assessment of veterans’ satisfaction with their care, their perceived ability to access care, their perceptions about provider communication, and other aspects of their care experience. Veterans should also be involved in treatment decisions. Ideally, there will be a protocol for shared decisionmaking. Finally, treatment decisions should include family members and caregivers, according to the veteran’s preferences.

Components of veteran-centered care

  • Cultural competence: an understanding of military and veteran culture, as well as veterans’ experiences and identity
  • Ongoing assessment of veterans’ care experiences
  • Shared decisionmaking between the veteran and provider
  • Family/caregiver involvement in care, according to the veteran’s preferences


High-quality care is both accessible and timely. Veterans should not have to wait long to obtain the care they need. Furthermore, programs that provide high-quality care work to address and reduce or eliminate geographic, financial, sociocultural, and other barriers. Providing flexible payment options, transportation and lodging, and flexible scheduling can expand access to care for veterans.

Components of accessibility

  • Timely access to care
  • Reduced geographic, financial, sociocultural, and other barriers

Evidence-Based Care

High-quality care is based on the best available research evidence and adheres to clinical practice guidelines. Best available research evidence refers to scientific findings related to interventions, assessments, clinical problems, and patient populations in both laboratory and field settings, as well as clinically relevant results from basic research.

Evidence-based care begins with a comprehensive assessment to inform treatment. The research evidence strongly supports trauma-focused psychotherapy for veterans with PTSD, such as prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, or cognitive behavioral therapy. Veterans with TBI symptoms should receive coordinated treatment from a multidisciplinary team that includes neurology, physical therapy, neuropsychiatry, and other specialties. Appropriate screenings should be administered as needed to assess risk factors, such as suicidality and substance use. Evidence-based care also involves coordination across a veteran’s health care providers to ensure treatment continuity.

Components of evidence-based care

  • Treatments and practices that are backed by the best available research, adhere to clinical practice guidelines, and are modified and improved in response to new evidence
  • Comprehensive clinical and diagnostic assessment
  • Trauma-focused psychotherapy for PTSD
  • Multidisciplinary team-based treatment for TBI
  • Appropriate screenings for risk factors
  • Care coordination and treatment planning across veteran’s health care providers

Outcome Monitoring

High-quality care promotes the use of validated measurement tools, such as symptom rating scales, to assess and monitor clinical outcomes, guide treatment decisions, and facilitate coordination. It is also important to monitor the effects of treatment on veterans’ well-being, including day-to-day functioning, relationships, and life satisfaction.

Components of outcome monitoring

  • Use of validated instruments to assess clinical outcomes, guide treatment decisions, and facilitate care coordination
  • Regular assessment of veteran well-being and functioning

Recommendations and Considerations for Operationalizing a Shared Definition of High-Quality Care:…

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