Outpatient Social Work Services With Combat-Related Polytrauma Patients

BACKGROUND AND PURPOSE: Due to advances in military field medicine, combat-injured service members are surviving at much higher rates than in prior conflicts. Service members are returning home with polytrauma injuries, disabilities, and rehabilitation expectations that present new challenges for coordination across the continuum of care. In order to address these needs, Congress mandated that the VA provide care for these returning service members. This mandate allowed the VA to prioritize care for complex polytrauma injuries incurred in combat, leading to the development of the Polytrauma System of Care. It also resulted in explicit recognition of social work’s essential role in coordinating this care. There are no known studies, however, that examine this role by exploring patterns of diagnostic and procedural coding for social work services with combat-related polytrauma patients. This limits the ability of VA policy makers and service providers to operationalize social work’s role in the care continuum. The primary objectives of the study are to: (1) characterize outpatient social work encounters; and (2) characterize diagnostic coding for social work procedures.

METHODS: The research design is a retrospective cohort study of Afghanistan and Iraq service members with combat-related polytrauma injuries who received outpatient social work services at the Tampa VA between 2007 and 2011. We use secondary data extracted from VHA Medical SAS Outpatient databases that were then cross-validated with patient charts from CPRS. The sampling strategy is purposive and nonrandom with a sample size of 265. Descriptive and nonparametric statistics were used to address the research objectives.

RESULTS: Combat-related polytrauma patients had a total of 10,437 outpatient social work service encounters. Patients received 91 different outpatient social work service procedures. Unlisted evaluation and management services accounted for 48% of the codes.  Patients receiving outpatient social work procedures were coded with 115 different diagnostic codes. Unspecified psychosocial circumstances accounted for 48% of the coding. Social workers were the largest providers of outpatient social work service procedures with associated costs of $3,830,379.

CONCLUSIONS AND IMPLICATIONS: Results suggest a need to further operationalize social work service-related procedures and diagnoses and develop social work-specific outcomes. This has implications for both civilian healthcare systems' ability to maximize revenue margins and optimize the social work workforce, and Social Work's ability to advocate for social workers' services to combat-related veterans. VHA and civilian social workers, and those that administer social service programs, are advised to prepare for their roles in the management of the chronic and complex clinical and social needs of veterans with comorbid conditions across the continuum of care.