Objective To identify factors associated with transitioning from Military Health System (MHS) to Veterans Health Administration (VHA) care in post-9/11 veterans. Study Setting and Design Retrospective cohort study from the Long-Term Impact of Military-Relevant Brain Injury Consortium Phenotype Study. Data Sources and Analytic Sample Population-level data were analyzed from MHS and VHA electronic health data (FY2000-2020). Participants received ≥ 3 years of MHS care and separated from the military before October 1, 2016. The primary outcome was transition from MHS to VHA care after military separation. Covariates included demographic, military, and deployment characteristics at military separation; physical, mental, and substance use disorder (SUD) diagnoses, behavioral risk factors, and multimorbidity 2 years before military separation. Principal Findings Among 1,594,869 post-9/11 veterans, 81.9% were male, 54.2% active-duty, and 48.8% were ages 25–34. Of the 78% that transitioned to VHA care, 70% had combat deployments, 17.5% were women, and 38.5% were Asian/Pacific Islander, Black, Hispanic, or Native American. Pain (55.8%) and smoking history (40.8%) were most prevalent 2 years before military separation. Post-9/11 veterans diagnosed with schizophrenia average marginal effect (AME): 0.096, 95% CI: 0.0084–0.108 had a higher probability of transitioning to VHA care. Multimorbidity of TBI, PTSD, SUD, depression, or pain was associated with increased probability of transitioning to VHA care (AME: 0.043, 95% CI: 0.042–0.044). National Guard (AME: 0.089, 95% CI: 0.087–0.091) members transitioned more often than active duty members. Biracial/multiracial/multiethnic members (AME: −0.389, 95% CI: −0.395 to −0.383) had a lower probability of transitioning to VHA care. Conclusions Post-9/11 veterans with multimorbidity and significant disease burden experienced more MHS-VHA care transitions. Biracial/multiracial/multiethnic members may benefit from enhanced care coordination between the MHS and VHA to reduce disparities and improve population health in post-9/11 veterans. Future research should examine MHS-VHA care transitions in service members treated for suicidality.
Wooten et al. (Wed,) studied this question.