My name is Emily Brignone,
I'm affiliated with the Informatics, Decision-Enhancement,
and Analytic Sciences Center at VA Salt Lake City,
and I'm also an incoming Health Services Research Post-Doctoral Fellow
at the Center for Health Equity Research and Promotion
at VA Pittsburgh.
Precision Medicine is a medical model that emphasizes
the tailoring of healthcare decisions
and practices and services
to unique and individual patient needs.
Precision medicine is usually thought of
in terms of things like biomarkers in genes,
but at the VA, we have the opportunity to extend this approach
to include a focus on a broader range of factors that are related to health.
So, this can include things like military service experiences,
and exposures during military service,
as well as certain social determinants of health.
The VA serves are really diverse population of Veterans,
not only in terms of demographics,
but in terms of experiences in the military,
and unique health risks and health related needs.
In terms of the most recent cohort of Veterans
who have returned form conflicts in Iraq and Afghanistan,
some of them come home from service
and transition into civilian life just fine
and don't really have many issues.
But there are others who do encounter certain challenges,
and these can include challenges
that are related to physical and mental health,
or employment issues, or family issues, or economic issues.
In order to be responsive to these issues,
and really meet their needs, we have to engage them in care
that is responsive to those specific needs.
In doing so, we can help to mitigate some of the health disparities
that we see among this population.
We've recently learned that Veterans
who are discharged from service
for reasons that aren't routine—
so reasons other than expiration of term of service or retirement—
these Veterans tend to be vulnerable
to a range of adverse outcomes in the post-deployment period.
And among Veterans of recent conflicts in Iraq and Afghanistan,
about 30 percent are discharged under these non-routine conditions,
and the most common reason for this is disability.
And this can be physical, health issues
or mental health issues,
but they were severe enough that the service member
was unable to continue in the line of duty
and they were discharged.
Many of these Veterans make their way to the VA
following their discharge from service,
and they receive health services treatment
and many of them also receive service-connected disability benefits,
and these benefits are intended to offset any income
that my have been lost
as a result of these disabilities that were related to their service.
And what we've found is that although many of theses service members
who were discharged due to disability
are receiving these service-connected disability benefits,
they're actually at a higher risk for homelessness
in the post-deployment period.
And so while we found that there was some protection offered
by the service-connected disability benefits,
it doesn't fully mitigate the risk
that's associated with being discharged due to disability.
We've learned form these recent studies
that it seems that we need to pay more attention
to their long-term needs,
because results from this study indicate
that when they first return home from service,
they seem to be doing okay,
and their risk for homelessness isn't any higher
than those who were discharged under routine conditions,
but as time goes on,
their risk for homelessness increases and increases.
So we need to be responsive to maybe the changing needs
associated with disability over time.
There are several things that I really like about the VA.
One is how interdisciplinary the environment is.
I regularly have the opportunity
to collaborate with experts from across this wide range of domains,
so I work with clinicians,
and programmers, and statisticians,
and mathematicians, and fellow social scientists,
and it really results in this rich and stimulating environment
with so many fresh new ideas.
Another thing that I like about VA research
is the emphasis on translating research findings into practice.
There's a lot of research where that piece is overlooked,
but that's not at all true at VA, and this is evidenced in
the strong culture of collaboration between researchers
and clinical and operational partners.
So it really is a privilege to be engaged in this public service
and to continue to work towards that goal
of providing the best possible services
to those who have served and given so much.