7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
1/17
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
2/17
Deployment Healthcare
A holistic, efficient, and patient-centered
approach to the care of combat veterans
that proactively assesses for the common
and distinct issues of this population and
its subgroups.
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
3/17
Integrated Deployment Healthcare
Physical
Concerns:
Primary CareProvider
Psycho-socialConcerns:
Social Worker
Psychological
Concerns:
Mental HealthProvider
Veteran
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
4/17
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
5/17
The War Related Illness and Injury
Study Center (WRIISC)A national program in the Department of VeteransAffairs (VA), initially established in 2001 to address
deployment health issues from the First Gulf War.
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
6/17
ABOUT THE WRIISC
The WRIISC helps:
Deployed Veterans
Any era or conflict
Unexplained or unusual healthconcerns
Through:
Clinical assessment
Education Research
Risk Communication
http://images.google.com/imgres?imgurl=http://www.politopics.com/uploaded_images/soldier20embrace-757545.jpg&imgrefurl=http://www.politopics.com/2007/10/things-that-matter.html&usg=__EzC6csGKxVORkCkl7mYSDl0nr2s=&h=363&w=346&sz=36&hl=en&start=1&um=1&tbnid=UYdD5pVneN_-2M:&tbnh=121&tbnw=115&prev=/images?q=combat+veterans+++pics&hl=en&sa=N&um=17/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
7/17
WRIISC Synergies
Clinical Care
Observations from clinical care
lead to research questions and
testable hypotheses, highlight
gaps in provider and patient
knowledge.
Education
Education of patients and
providers can improve patient
outcomes and identify gaps in
knowledge to be addressed
by research.
Research
Research produces
knowledge and evidence-
supported interventions and
tools that can improve patient
care and can be packaged
and disseminated througheducation activities.
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
8/17
WRIISC REGIONAL MAP
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
9/17
CLINICAL EVALUATIONS
Comprehensive Interdisciplinary Evaluation Focus is on symptom management and improving function
Three day evaluation as pre-determined by WRIISC clinical team
Environmental Exposure Consults Comprehensive available for Veterans of any conflict
Attempts to link exposures to current health conditions
Educates patient about his/her exposure concerns
eConsults
Medical record review with individualized recommendations for next
steps prior to other WRIISC evaluations
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
10/17
Comprehensive Evaluation Patients
Complex, deployment-related health
concerns
Difficult to diagnosis, unexplained, or unusual
Concerns about deployment-related
exposures
Environmental & Occupational
Local work up inconclusive or unavailable
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
11/17
WRIISC Model of Assessment & Care
Holistic/biopsychosocial approach Interdisciplinary team
WRIISC team and patient craft goals &next steps (Road Map)
Focus on optimizing health and function
Emphasize self-management
Goal and outcome oriented
Encourage timely reassessment by PACT Follow up at 1, 6, and 12 months
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
12/17
Chronic Multisymptom Illness (CMI) atthe WRIISC
Review of the referrals
Team meeting and in the road map
Use of labels for chronic fatigue syndrome,fibromyalgia, and irritable bowel syndrome
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
13/17
Symptoms reported by Veterans whocompleted NJ WRIISC intake packet
PHQ-15 symptom % Gulf War (n=46) % OEF/OIF/OND (n=66) Vietnam (n=28)
Stomach pain 24.4 19.7 32.1
Back pain 71.1 62.1 46.4
Pain in your arms, legs, or joints
(knees, hips, etc.)80.0 53.0 60.7
Menstrual cramps or other
problem with your periods
(Women only)
15.8 9.1 0
Headaches 48.9 39.4 17.9
Chest pain 11.1 9.2 10.7
Dizziness 17.8 31.8 7.1Fainting spells 0 4.6 0
Feeling your heart pound or race 15.6 27.3 3.6
Shortness of breath 26.7 17.2 32.1
Pain or problems during sexual
intercourse29.5 27.3 28.0
Constipation, loose bowels, or
diarrhea48.9 45.5 25.9
Nausea, gas, or indigestion 48.9 39.4 36.0
Feeling tired or having low energy 91.1 78.8 55.6
Trouble sleeping 88.9 83.3 63.0
PHQ-Depression 58.7 62.1 41.4
PCL-PTSD (>50) 39.1 43.9 24.1
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
14/17
VHA encounters by GW Veteransbefore and after WRIISC Visit(Samore et al, IDEAS Center, SLC VAMC)
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
15/17
ICD9 codes associated with GW Veterans VHA
encounters before and after a WRIISC visit(Samore et al, IDEAS Center, SLC VAMC)
0
1000
2000
3000
4000
5000
6000
7000
In the one year PRIOR toWRIISC visit
In the one year AFTERWRIISC Visit
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
16/17
7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.
17/17
WRIISC CONTACT INFO www.warrelatedillness.va.gov
NJ WRIISC: 1-800-248-8005 or
CA WRIISC: 1-888-482-4376 or
DC WRIISC: 1-800-722-8340 or
http://www.warrelatedillness.va.gov/mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.warrelatedillness.va.gov/Top Related