Advancing veterans' healthcare using electronic data: Lessons learned from researchers in the field

Abstract

The Department of Veterans Affairs (VA) provides nationwide access, lifetime coverage, and an integrated care structure to its enrollees. Those key aspects of VA healthcare--together with data contained in VA's electronic information systems supporting over eight million veterans--provide unique opportunities to study processes, outcomes, and costs of care. Recently, for example, VA data have been used to study outcomes associated with acute postoperative inpatient rehabilitation and care in specialized rehabilitation bed units after lower-limb amputation [1-2], medication adherence and relapse among patients discharged from a VA posttraumatic stress disorder (PTSD) treatment program [3], the provision and costs of assistive technology devices to veterans after stroke [4], and use of mental health services by veterans disabled by auditory disorders [5]. UNDERPINNINGS OF SINGLE-TOPIC ISSUE ON DATA QUALITY In 1998, the VA Health Services Research & Development Service funded the VA Information Resource Center (VIReC) to facilitate the use of VA administrative data for research. Since that time, VIReC has developed and disseminated research-relevant information about VA databases and information systems. Knowledge-building activities include data quality investigations conducted within VIReC. This single-topic issue recognizes the vast stores of information about VA data that VA investigators generate nationwide, in the normal course of their data analysis activities, and seeks to leverage that information to advance electronic-data-based research. A call for abstracts was issued in the spring of 2009 for investigations of the quality and research utility of electronic data used in research to advance the care of veterans. VA investigators responded--many more worthy abstracts were submitted than could be included in one JRRD issue. Reflecting strong research-community support for VA research, 54 scholars readily accepted invitations to peer review and almost 100 individuals participated as authors, reviewers, or editors. VA researchers have long been major contributors to the methodological literature in the area of administrative data use [6-17]. This issue advances that literature by focusing specifically on the quality and research utility of databases used in veterans research. We view data quality--roughly, the completeness and accuracy of the data collected and entered--as a necessary but not sufficient feature of a research-useful data set [18]. The research utility of a data set entails additional factors such as coverage of the population of interest and degree of validity achievable when specific data elements are used as proxies for important but absent information. Research utility questions, therefore, relate to the inevitable challenges involved in the use of secondary data--i.e., data that were collected for a different purpose--rather than a deficiency in the data per se. VITAL VETERANS RESEARCH AND VA HEALTH INFORMATION SYSTEMS The questions of data quality and research utility addressed in the included articles were encountered during research tackling key issues in the care and rehabilitation of wounded war veterans. Promoting high-quality care and providing the tools for independent living to veterans with spinal cord injury (SCI) [19], polytrauma [20], PTSD, substance-use disorder and other mental health conditions [21-23] and to others needing rehabilitative and assistive services [24-25] are high VA priorities. Investigating obesity and chronic kidney disease and its antecedents are important because these are among the most common chronic conditions afflicting veterans seeking care in the VA [26-27]. Understanding the healthcare needs and ensuring accessible care for women and other vulnerable populations [23,28-30] are among the VA's top research priorities. Identifying cost-effective approaches to veterans' healthcare [25,29,31] is critical to long-term viability of the VA healthcare system. …