War Related Illness and Injury Study Center (WRIISC): A Multidisciplinary Translational Approach to the Care of Veterans With Chronic Multisymptom Illness

Abstract

INTRODUCTION Chronic multisymptom illness (CMI) is defined as the presence for at least 6 months of one or more of the following three symptom complexes: musculoskeletal pain, general fatigue, and mood or cognitive problems. CMI has been documented after armed conflicts since the Civil War and unfortunately has surfaced again as Veterans return from the theaters of operation in Afghanistan and Iraq. CMI is a complex chronic health condition where symptoms may vary depending on a Veteran’s era of deployment and the presence of other comorbid disorders. Because of the disparate nature of the symptoms, Veterans with CMI often see many providers in multiple specialties, resulting in poorly coordinated or conflicting treatment plans. Further, clinical research on CMI is in its infancy with few established treatments. Without a more systematic approach to the evaluation of these efforts, evidence-based best practices will remain elusive. We and others argue that an interdisciplinary and translational approach, moving research from basic science to clinical applications, is optimal to improve the care of patients. Current understanding of best practices includes the need for timely and accurate recognition of CMI in primary care; the development and implementation of a multidisciplinary management plan that facilitates self-management of symptoms; and scheduled oversight of this plan by health-care personnel with diverse skills. Bringing a multidisciplinary team of providers, researchers, and educators together to evaluate Veterans improves the care of the individual Veteran and provides system-wide benefits. TheWar Related Illness and Injury Study Centers (WRIISCs), conceptually related to theVeteransHealth Administration’s (VHA’s) Patient Aligned Care Team (PACT) initiative, represent examples of the Veterans Affairs (VA) multidisciplinary, translational approach to CMI. In 2001, in response to a Congressional mandate, the VA Office of Public Health implemented the WRIISCs to focus on the post-deployment health concerns of Veterans and their unique health-care needs. The WRIISC mission is “to develop and provide expertise for Veterans and their health care providers through clinical evaluation, research, education, and risk communication.” The four-pillared approach is implemented across the WRIISC program at three VA Medical Center sites: East Orange, NJ; Washington, DC; and Palo Alto, CA.