The Department of Veterans Affairs (VA) and the Department of Defense (DoD) work jointly to develop Clinical Practice Guidelines (CPG) for their beneficiary populations. Originally CPGs were developed by the VA alone. However, in the late 1990's Congress recognized that CPGs had an important role in improving the quality of care, patient outcomes, and patient satisfaction in all patients. Subsequently Congress ordered the DoD to join the VA and produce and implement guidelines jointly. In the years since the two organizations began collaborating on guidelines, they have developed 24 CPGs which have been recognized by the Institute of Medicine (IOM) as some of the best guidelines in the industry.
Recently the VA/DoD completed a joint project to update the CPG for the treatment of Concussion - Mild Traumatic Brain Injury. The definition of a concussion -- mild traumatic brain injury is a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force and is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event:
- Any period of loss of or a decreased level of consciousness
- Any loss of memory for events immediately before or after the injury (posttraumatic amnesia)
- Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state)
- Neurological deficits (e.g., weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient
- Intracranial lesion
Work on this effort began 14 months ago and included a complete review of all evidence related to the treatment of this condition. A group of 23 subject matter experts from both the VA and the DoD then reviewed the evidence to develop treatment recommendations. The resulting CPG guides providers in the care of patients with a history of mTBI along the management pathways that are supported by evidence. Use of this guideline will allow healthcare providers to:
- Assess the patient's condition and determine the best treatment method
- Optimize the clinical management to improve symptoms and functioning, adherence to treatment, recovery, well-being, and quality of life outcomes
- Minimize preventable complications and morbidity
- Emphasize the use of patient-centered care
The VA/DoD Concussion -- Mild Traumatic Brain Injury Clinical Practice Guide is now available on the
Army website at: https://www.qmo.amedd.army.mil/pguide.htm
or on the VA website at: http://www.healthquality.va.gov/
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