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Registries Deliver Valuable Data for Sensory Injury Research

Image of Registries Deliver Valuable Data for Sensory Injury Research. Stacy Leonard, left, and Christina Stretch, Hearing Center of Excellence Information Management Section, demonstrate some of the capabilities of the Joint Hearing Loss and Auditory System Injury Registry at the Joint Defense and Veterans Audiology Conference in March 2023. (Department of Defense photo: Larine Barr, MHS Communications)

Military sensory research—and the development of clinical best practices—are fueled by vision and hearing injury registries that collect data on service members and veterans from their point of injury to recovery or rehabilitation.

The Defense Health Agency’s Vision Center of Excellence hosts the Defense and Veterans Eye Injury and Vision Registry. Known as DVEIVR, the registry improves treatment for eye injuries across the Department of Defense and the Department of Veterans Affairs and has an accuracy rate of 99.9%.

DHA’s Hearing Center of Excellence manages the Joint Hearing Loss and Auditory System Injury Registry. JHASIR promotes analysis, research, performance improvement, and continuity of care of service members and veterans with hearing-related injuries. It also corrects the gaps that separate hearing health and auditory-vestibular injury, said Stacy Leonard, information management program manager at HCE on Joint Base San Antonio-Lackland, Texas.

DVEIVR and JHASIR use cutting-edge technology to establish bi-directional data pulls between DOD and VA medical information systems based on medical records. This interface securely compiles current and historical medical records and provides a unique resource containing standardized data, according to VCE.

How the Databases Work

Both DVEIVR and JHASIR contain data on active duty service members, the National Guard and Reserve, and veterans from 2001 to now. The data come from inpatient and outpatient Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care provided at military hospitals and clinics, Click to closePurchased CareThe TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts.purchased care from non-military treatment facilities, and the VA. Pharmacies, laboratories, and radiology centers also are sources of data.

The two congressionally mandated registries manage reports and dashboards that provide customized information to showcase diagnostic techniques and procedures as well as various demographic data collected over time, such as injury prevalence rates, VCE said.

“The combination of clinical health registries at different levels can produce very large data that enable opportunities to evaluate patient outcomes and inter-systems comparisons,” said Dr. Mariia Viswanathan, VCE vision care readiness section chief. “Records from point of injury to treatment and rehabilitation and back to duty, and injury evaluation are all potential parameters that can be used for research analysis.”

The two registries combined create collaboration and synergies between the two Centers of Excellence that serve as a model for future collaborations, VCE said.

How the Data Are Used

Data from DVEIVR and JHASIR on risk factors, exposures, diagnoses, treatments, and outcomes are used in case studies, correlational studies, longitudinal studies, retrospective cohort studies, and meta-analyses.

Each entry in the registries is associated with unique patient IDs that can be cross-referenced by researchers. This provides a real-world view of clinical practice, patient outcomes, safety, and comparative standards, and has reduced the cost of delivering care, according to VCE.

For example, data from DVEIVR were used in an investigation of visual dysfunction secondary to traumatic brain injury. VCE, in collaboration within DOD and VA, including the Traumatic Brain Injury Center of Excellence, championed the production of clinical recommendations for the care of visual dysfunction after TBI. These aids to clinical care include “Eye and Vision Care Following Blast Exposure and/ or Possible Traumatic Brain Injury,” “Care of Visual Field Loss Associated with Traumatic Brain Injury,” and “Care of Oculomotor Dysfunctions Associated with TBI.”

DVIEVR data were also used to support development of multiple clinical practice guidelines to provide expertise across the clinical spectrum of eye care for a patient. The CPGs are titled “Ocular Injuries and Vision-Threatening Conditions in Prolonged Field Care” and the “Evaluation and Disposition of Temporary Visual Interference and Ocular Injury after Suspected Ocular Laser Exposure.” DVEIVR data can benefit analysis of treatments for ocular injuries and determine if one treatment plan is more effective than another in returning military members to full-duty status.

JHASIR data have been used to help monitor and report on the status of overall force hearing, according to Leonard. She said it “raises awareness of auditory injury and allows for more effective interventions to prevent or reduce the severity of auditory injuries.”

Project researchers also have pulled demographic data and occupational hearing health data from JHASIR to identify risk factors that may increase the likelihood of service members sustaining auditory injury from noise exposure as part of a multi-site field study with Walter Reed National Military Medical Center called CHASMPAS (Characterization of Acute or Short-term Acquired Military Population Auditory Shifts). The study is focused on characterizing short-term changes in hearing among military personnel exposed to blast. So far, 170 service members have participated in the CHASMPAS study from multiple U.S. Army, U.S. Navy, and U.S. Marine Corps sites.

Another example of how JHASIR data are used is the DOD/VA TRICARE hearing aid demonstration, which aims to replicate, to the fullest extent possible, the VA's Community Care Network model for delivery of prescribed hearing aids and associated devices for veterans, active duty service members receiving care through the supplemental health care program in designated states, as well as to qualifying Prime active duty family members diagnosed with profound hearing loss. The demonstration is set to launch in 2023 and it was supported by JHASIR data, said Amy Boudin-George, a doctor of audiology and clinician scientist in the HCE Studies and Analysis Section.

Boudin-George added that HCE has also developed clinical practice reference documents for providers who see patients with hearing and balance issues or for hearing conservation purposes. “JHASIR has been the key data source for us to track the use of those documents in clinical practice,” she said.

In March 2023, researchers from Brooke Army Medical Center used data from JHASIR to publish a study in the American Journal of Otolaryngology examining the rates of sudden hearing loss by characterizing treatment options during the COVID-19 pandemic. The researchers concluded COVID-19 infections do not significantly increase patients’ risk of losing their hearing.

“Registries can give cost-effectiveness analyses of various health care practices, incorporate measures of short-and long-term survival, and functional outcomes effectiveness of care and rehabilitation,” Viswanathan said. “With the purpose of monitoring quality of care, providing feedback, and describing patterns of treatment, registries are valuable tools for conducting research.&rdquo

How to Access the Registries Data

Access to DVEIVR is available by request to CAC and PIV users through the military’s CarePoint information portal. Academics can request data from DVEIVR through a Data Request Form.

JHASIR is also available via CarePoint and has a unique tile on the portal landing page.

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