Monitoring VHA Optometric Eye Exam Services, Nation-Wide, 2014–2016

MILITARY MEDICINE, 183, 9/10:e272, 2018 Monitoring VHA Optometric Eye Exam Services, Nation-Wide, 2014–2016 Gregory Fant, PhD, MSHS, MPA*; Lisa Backus, MD, PhD† INTRODUCTION Veterans Affairs (VA) optometrists provide optometric care and treatment services to eligible Veterans using the Veterans Health Administration (VHA) system in order to help improve eye and vision health. The delivery of optometry services at the VHA is, generally, concerned with promoting health of the eye, vision, visual system, and visual information processing. Good eyesight allows the Veteran to perceive and interpret the world and is crucial to improving many activities of daily life, such as personal hygiene, independence, and mobility; poor eyesight increases the risk of falling, social isolation, and depression.1 Veterans with eye conditions related to military service have unique optometric service needs. Veterans who are visually impaired may be eligible for VA’s vision health benefits.2 These benefits include a range of vision care services that include primary eye care services to intermediate and advanced clinical vision care – including vision-enhancing devices, and specialized training for Veterans in the use of innovative vision technology. For Veterans who have low vision or are blind, the VHA offers vision rehabilitation centers. These centers *US Department of Veterans Affairs, Veterans Health Administration, Patient Care Services, Population Health Services, Washington, DC †US Department of Veterans Affairs, Veterans Health Administration, Patient Care Services, Population Health Services, Palo Alto, CA doi: 10.1093/milmed/usx192 Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US. e272 focus on enhancing skills such as communication, orientation, and mobility, in addition to manual skills and learning to use low-vision devices to help cope with daily living activities. Since 1976, the VHA Optometry Service has been providing the majority of primary eye care and low vision rehabilitation services for our Nation’s Veterans: VHA estimates that by 2020 there may be over one million veterans eligible who use the VHA system and who have significant visual impairment and legal blindness.3 These Veterans could use varying levels of low vision and blind rehabilitation services. Primary eye and vision care4 begins with the optometric eye exam and the results of this exam directs optometric treatment to prevent vision loss, correct for refractive errors, and help conserve remaining vision in the Veteran population. The discipline of managerial epidemiology might aid in monitoring the use of optometric services in order to guide health resource planning efforts for public health action. We did not find recent public health reports that documented the utilization of VHA optometric eye exam services, nationwide. Public health monitoring reports that utilize concepts from managerial epidemiology may assist in health resource planning and interpreting data for system-level national, region, and/or facility – public health action.5 Managerial epidemiologic concepts and methods may help describe the utilization of health services for an intended population, in this case – the recent use of optometric eye exam services among Veterans using the VHA system between 2014 and 2016. This public health brief report was developed to address two purposes. First, the brief report will describe the MILITARY MEDICINE, Vol. 183, September/October 2018 ABSTRACT Introduction: It is important to monitor the use of optometric services by Veterans and consider the implications for other optometric and vision rehabilitation services. We did not find public health reports documenting the recent utilization of Veterans Health Administration (VHA) optometric eye exam services. Methods: A crosssectional study design was used in this secondary data analysis report. We were interested in reporting on the number of Veterans using the VHA system with at least one VHA optometric eye exam service in 2014, 2015, or 2016 within a VHA optometry clinic. The data from Veterans were derived from the VHA Corporate Data Warehouse. Results: The number of unique Veteran patients who had at least one indication of VHA optometric eye exam service, nationwide, increased from 1.4 million Veteran patients in 2014 to 1.6 million patients in 2016. The percentage of Veterans using VHA optometric eye exam services out of all unique VHA patients receiving care in the VHA system in 2014, 2015, and 2016 was 25.4%, 25.8%, and 26.8%, respectively. During each year of this time period, about 94% of the Veteran patients were male using optometric eye exam services. Florida, California, Texas, Ohio, and New York had the largest number of Veterans using optometric eye exam services, at least once, in 2014, 2015, or 2016. Conclusion: Veteran patients who made at least one VHA optometric eye exam service visit, nation-wide, increased from 2014 to 2016. Data showed that Veteran patients in the older age groups (age 55 and greater) used optometric eye exam services differently when compared with Veterans in the younger age groups. This difference may invite consideration of the differing optometric needs of these two, broad groups of eligible Veterans in order to expand access to VHA optometric clinical services. Monitoring VHA Optometric Eye Exam Services, Nation-Wide, 2014–2016 use of at least one VHA optometric eye exam service among eligible Veterans (by sex, age group, and selected states) from 2014 through 2016, nation-wide. Second, we examine if there is an association between sex and VHA optometric eye exam services in 2014, 2015, and 2016, and, separately, for age group and optometric eye exam services. The insights from this public health brief report might help inform VHA health resource planning and related decision-making on this topic. Unique identifier (non-ssn). Within the CDW, the PatientICN was chosen as the unique patient identifier as the most accurate for identifying a unique patient within the CDW database. Sex. The sex recorded in the CDW for the individual patient in the specific year. Age. The age recorded in the CDW for the individual patient when the first optometric eye exam service was used in the specific year. State. The state where the first, optometric service was recorded in the CDW for the individual patient in a specific year. Optometric eye exam services. At least one CPT code in any year of the selected years with any of the following CPT codes as recorded in the CDW: 92002 and 92004 = Eye Exam New Patient; 92012 = Eye Exam Established Patient; 92014 = Eye Exam and Treatment of Established Patient with more than 1 visit; 92015 = Eye Exam to Determine Refractive State. We collected the number of unique, Veteran patients with VHA expenditures recorded in each state from t (...truncated)