Adaptation of life care planning to patients with polytrauma in a VA inpatient setting: Implications for seamless care coordination.

As of March 2006, more than 1.3 million U.S. military service members had served or were serving in Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF). Both active duty and veteran service members are eligible to receive healthcare services from the Department of Veterans Affairs (VA). In May 1982, Congress passed legislation that allowed the VA to provide healthcare services to active duty service members during wars or national emergencies. The Veterans Health Programs Improvement Act of 2004 (Public Law 108-422, § 302, 118 Stat. 2379, 2383-86) mandated the VA to create research, education, and clinical activity centers focused on the complex multiple trauma associated with combat injuries. In response, the VA created five Polytrauma Rehabilitation Centers (PRCs) within five large medical facilities (located in Palo Alto, California; Tampa, Florida; Richmond, Virginia; Minneapolis, Minnesota; and San Antonio, Texas [under construction]). These PRCs provide integrated and interdisciplinary rehabilitation medicine to severely injured combat personnel. In addition to establishing the five PRCs, the VA, the Department of Defense (DOD), and other Government agencies have examined ways to provide a “seamless transition of care” across the battlefield, military treatment facility (MTF), VA facility, and community. Seamless transition of care refers to the careful and well-coordinated transfer of active duty and recently discharged service members from an MTF to a VA facility. It includes establishing VA points of contact within the DOD and DOD points of contact within the VA. Because the VA has undertaken a larger role in treating active duty service members, the seamless transition of care requires bidirectionality between the VA and MTF before, during, and after treatment at the VA.