VA suicide prevention update: Investigators with VA and the University of Washington say sophisticated searches of the free text in VA patients’ electronic medical records may be a way to identify those at risk of suicide. The researchers presented their findings at the 46th annual Hawaii International Conference on System Sciences last month.

The team used two data sets, on 10,000 and 100,000 Veterans, respectively, and developed search terms to query clinicians’ notes for indicators of suicide risk. They homed in on clinical notes indicating past suicide attempts. This is the strongest signal of risk, according to studies. Next are depression, bipolar disorder, schizophrenia, and alcoholism.

One of the challenges was weeding out records that contained the words “suicide attempt” or similar phrases but that were simply part of clinicians’ documentation of suicide screenings, with no positive findings. Eventually, the researchers came up with query terms that were reasonably precise in finding actual suicide attempts as documented in the notes. Using the smaller data set, they zeroed in on 2,210 documents — belonging to 597 patients — that contained significant language indicating past suicide attempts. A psychiatrist manually reviewed the records and classified 402 of the patients as “true positives.” In other words, the automated method was about 80 percent accurate.

The researchers wrote, “We show the potential for text search to readily identify high-risk individuals who have attempted suicide at some point in their lives.” They plan to further refine the search methodology to yield even more precise results. Currently, VA securely stores electronic medical records on nearly 10 million Veterans, current and past patients. The records contain some 1.2 billion documents in all. The records are made available to authorized VA researchers with strict privacy safeguards in place. The suicide study was part of a larger VA research initiative aimed at using natural language processing to extract clinically meaningful information from doctors and other clinicians’ free-text entries in Veterans’ medical records. Free text is more difficult to “mine” than structured data—such as checkboxes or radio buttons — but researchers are using Google-like technology and other tools to teach computers how to recognize key phrases. [Source: VA Resource Currents Feb 2013]

VA mental health care update: Despite more money and more staff to tackle the problem, veterans aren’t seeing enough progress toward getting mental health care, the chair of the House Veterans Affairs Committee said 13 FEB. Rep. Jeff Miller (R-FL) the extra funding and effort by the Department of Veterans Affairs seems to be going toward more bureaucracy and not better care for veterans. That’s particularly concerning with the wave of Iraq and Afghanistan servicemembers expected to reach the department in coming years.

“The true measure of success with respect to mental health care is not how many people are hired but how many people are helped,” he told VA officials during a hearing Wednesday. “It has become painfully clear to me that the VA is focused more on its process and not its outcomes.”

The comments came during a hearing examining recent struggles of the department. Veterans Health Administration Undersecretary for Health Robert Petzel countered that the department is on the right path, but acknowledged they still have a daunting task ahead. Veterans Affairs officials have seen a steady rise in the number of veterans seeking mental health care in recent years, from about 927,000 cases in fiscal 2006 to more than 1.3 million in fiscal 2012.

Earlier this week, department officials announced they have hired more than 1,280 clinical providers and support staff to new posts in the last five months, part of an effort to add 1,900 new mental health specialists. They’ve also filled 1,980 vacant mental health positions since last summer, and increased the number of crisis workers and phone lines. In a statement, VA Secretary Eric Shinseki said the moves mean that “we can treat more veterans and provide greater access to our mental health services.” But lawmakers remain frustrated that the agency isn’t moving fast enough to respond to veterans battling problems like post-traumatic stress disorder and traumatic brain injury.

A VA Inspector General report found that veterans seeking any mental health care in the department wait an average of 50 days before getting treatment. Earlier this month, a new VA study found that 22 veterans a day committed suicide in 2010, and increase from 18 a day just three years before. Veterans advocates say they still see fundamental flaws in the department’s approach to treating troubled former troops, which leads to the disappointing results. Linda Spoonster Schwartz, commissioner of the Connecticut VA, said families are often shut out of treatment programs, despite research showing significant benefits in including them. David Rudd, director of the University of Utah’s Center for Veterans Studies, said VA’s preference to add staff rather than coordinate with private physicians leaves rural veterans with long drives to seek care.

But Petzel said he has seen positive signs of progress. While calls to the department’s suicide hotline are up, the percent of actively suicidal vets is down. Officials say veterans who receive VA care are also less likely to take their own lives. “We are making a difference,” he said.

In his State of the Union address Tuesday night, President Barack Obama promised that “we will keep faith with our veterans, investing in world-class care — including mental health care — for our wounded warriors.” Petzel said the department is working to launch 15 pilot programs on working more closely with community health providers, to see whether that might solve some rural veteran access problems. They’ve also expanded online health care programs and readjustment counseling options for veterans.

But Rep. Jon Runyan (R-NJ) said the department’s efforts still seem more reactive than proactive, jumping from one crisis to another. Several lawmakers and veterans advocates said they worry the department still reaches only a small segment of the veterans population, leaving tens of thousands of troubled individuals without any help.“VA must stand ready to treat our veterans where and how our veterans want, not just where and how VA wants,” Miller said. [Source: Stars and Stripes | Leo Shane | 13 Feb 2013]