Improving Care and Outcomes for Veterans with Post-Traumatic Epilepsy

Principal Investigator: HANEEF, ZULFI

Institution Receiving Award: BAYLOR COLLEGE OF MEDICINE

Program: ERP

Proposal Number: EP230097

Award Number: HT9425-24-1-0355

Funding Mechanism: Virtual Post-Traumatic Epilepsy Research Center - Faculty Award

Award Amount: $839,745.00

Period of Performance: 5/1/2024 - 4/30/2027

PUBLIC ABSTRACT

Our research project aims to address the challenges faced by Veterans with post-traumatic epilepsy and improve their care and outcomes. PTE is a condition that affects individuals who have experienced brain injuries. Among Veterans, this is often as a result of trauma during military service. Our goal is to understand the factors contributing to higher mortality rates and differences in healthcare access among Veterans with PTE, and to develop recommendations for interventions that can make a real difference in their lives.

Veterans with PTE face unique challenges that impact their quality of life and likely suffer from increased mortality. We want to better understand the causes of increased mortality rates and the barriers Veterans with this condition face in accessing appropriate care. By identifying these factors, we can develop strategies to improve healthcare access, reduce mortality rates and enhance the overall well-being of Veterans living with PTE.

The research outcomes will directly benefit Veterans with PTE and their families. By improving access to comprehensive epilepsy care and reducing mortality rates, we aim to enhance the quality of life for these individuals. Our research will contribute to advancing the understanding of PTE, leading to improved healthcare practices and tailored treatments for Veterans in need.

The findings from this research will inform healthcare providers and policymakers about the specific needs of Veterans with PTE. This will lead to the development of targeted interventions and tailored treatment plans, ultimately resulting in improved healthcare access and outcomes. By reducing mortality rates and addressing disparities in care, we can enhance the lives of Veterans with PTE and ensure they receive the support they deserve. The development of Houston as a PTE research center and the development of a PTE-specific database of all Veterans with epilepsy are anticipated to accelerate further study and improve care within and outside the VA.

The overall proposed timeline for outcomes is three years. Our research will have milestones along the way that contribute to the overall goal of improving care and outcomes for Veterans with PTE. These milestones include identifying factors contributing to mortality rates (1 year), understanding disparities in care utilization (2 years), and developing recommendations for interventions (3 years). An expert panel of epilepsy specialists and patients will develop recommendations for care and help circulate these recommendations to the clinic and other points of care over the third year. The benefits of these changes will grow over future years.

This research project will significantly contribute to the field of PTE research by providing valuable insights into the causes of mortality and disparities in care among Veterans with PTE. By understanding these factors, we can shape policies and practices to bridge the gaps in healthcare access and ensure more equitable outcomes for this population. Ultimately, our research aims to make a positive impact on the lives of Veterans with PTE, enhancing their quality of life and providing them with the care they need.

Dr. Zulfi Haneef, the principal investigator, is committed to becoming an established researcher in the field of PTE. Through participation in the Virtual Post-Traumatic Epilepsy Research Center, Dr. Haneef will have opportunities to collaborate with experts, gain diverse perspectives and further his knowledge in PTE research. This collaboration will help him refine his research ideas, secure funding and navigate the publication process, ensuring that his career goals align with making meaningful contributions to the field and improving the lives of Veterans with PTE.

TECHNICAL ABSTRACT

Background: This proposal seeks to develop intervention strategies to improve outcomes, reduce mortality and increase healthcare equity for Veterans with post-traumatic epilepsy. The study will be conducted in collaboration with the Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE). Compelling evidence suggests that worse outcomes including mortality in VWPTE is higher than other Veterans with epilepsy. The reasons for poor outcomes are likely related to reduced access to care available within the VHA system. However, it remains unclear what barriers are preventing access to care, and this warrants urgent investigation. Identifying and addressing remediable causes of preventable mortality is critical in this highly vulnerable population.

Hypothesis or Objectives: The study aims to establish and identify the causes of increased mortality in VWPTE, identify causes of poor outcomes with VWPTE, survey disparities in epilepsy care for VWPTE and develop intervention strategies to reduce mortality and promote healthcare equity.

Specific Aims: The specific aims of the study are as follows:

Aim 1: Evaluate mortality rates and causes of mortality among VWPTE.

Aim 2: Examine the association of social determinants of health with healthcare outcomes for VWPTE.

Aim 3: Identify barriers to care faced by VWPTE using a survey and develop intervention strategies to overcome such barriers by a panel including providers and VWPTE.

Study Design: The study design includes evaluating mortality rates and causes using administrative databases (VHA Corporate Data Warehouse, Mortality Data Repository); examining the association of social determinants of health (e.g., race, sex, social deprivation) on care utilization (e.g., specialized care, investigations) and outcomes (e.g., mortality, emergency visits, inpatient hospitalization); and conducting a survey among Veterans with PTE to identify barriers to care access and utilization. Based on findings, a panel of providers and VWPTE will develop intervention recommendations to improve healthcare access and outcomes in VWPTE.

Impact: The findings and recommendations from this study have the potential to reduce mortality rates and improve healthcare access and outcomes for Veterans with PTE. The study aims to enhance provider knowledge, promote health equity and refine the paradigm for population-based administrative data studies in the field of epilepsy. The development of Houston as a virtual PTE research center and the development of a PTE-specific database of all Veterans with epilepsy are anticipated to accelerate research into Veterans with PTE in the future.

Career Development and Sustainment: Dr. Zulfi Haneef, the principal investigator, has a strong clinical and research track record. As the Director of the ECoE at the Houston VA, he has demonstrated exceptional leadership skills and made significant contributions to epilepsy research. To support his growth as an independent PTE researcher, a comprehensive career development and sustainment plan has been developed. The plan includes workshops, conferences, mentoring opportunities, and milestones for obtaining research funding and publishing in peer-reviewed journals under the mentorship of Dr. Alan Towne, who is the National ECoE Director and has considerable PTE research experience.

Participation in the Virtual Post-Traumatic Epilepsy Research Center (P-TERC) is crucial for Dr. Haneef's career development. The P-TERC provides a platform for networking, collaboration and knowledge sharing among researchers and Career Guide pairs. Through this collaboration, Dr. Haneef will gain exposure to diverse perspectives and research methodologies, expanding his expertise in PTE research.

Overall, this proposed project aims to address the pressing issues of mortality rates and disparities in care for Veterans with PTE. It combines rigorous research methods, a comprehensive career development plan and participation in the Virtual P-TERC to make significant contributions to the field and improve healthcare outcomes for this vulnerable population.