- The Washington Times - Wednesday, December 24, 2014

Veteran suicide is a major issue on Capitol Hill, but policymakers may be making decisions based on incomplete or inaccurate data, according to several investigations that suggest depression could be a far larger problem than the one-in-10 figure the Department of Veterans Affairs cites.

Investigators found that almost two-thirds of the forms used to track veterans’ suicides were incomplete. Some lacked critical information such as the date the veteran died or when the veteran was treated at a VA hospital.

A data entry error and vague standards for doctors writing reports may mean the number of veterans suffering from serious depression could be much higher than the 10 percent the VA reports.

The Government Accountability Office also found that no one was charged with checking the accuracy of the forms at the central office, suggesting the problem could be much wider than the six hospitals that the GAO sampled.

“Lack of complete, accurate, and consistent data and poor oversight can inhibit VA’s ability to identify, evaluate, and improve ways to better inform its suicide prevention efforts,” the GAO report said.

Lawmakers stalemated this month on a bill to bring more resources to the VA to try to lower the rate of suicides. One key provision would have pushed the VA to study best practices to see what programs work.

A Defense Department inspector general’s report from November found a high number of “don’t know” or “data unavailable” answers in suicide questionnaires from 2011, the most recent year data were available, suggesting the problem of inaccurate record-keeping extends beyond the VA.

But wrong or incomplete data could frustrate that research.

Rep. Mike Coffman, Colorado Republican and chairman of the House Veterans’ Affairs oversight subcommittee, said lawmakers need to do more to ensure these mistakes aren’t made so veterans get the best care possible.

“The GAO study shows just how broken the VA mental health system is and how it is letting down our veterans when it comes to suicide prevention,” he said in a statement. “The work must continue in order to fully understand the depth of this problem and how we can fix what appears to be another example of a VA bureaucracy that just doesn’t seem to care about taking care of our veterans.”

The GAO report made several recommendations, all of which the VA said it is working to implement before the end of next year: setting up a process to review forms for accuracy and completeness before sending them to the central office, and releasing clearer guidelines to make sure forms are filled out consistently among different providers or hospitals.

The report also found that the VA was not doing enough to track and follow up with patients who suffered from serious depression.

Because of coding errors and imprecision in the way a physician may enter a diagnosis, the number of veterans who suffer from major depressive disorder may be much higher than the 10 percent reported by the department.

A glitch in the system made it so that even when doctors selected major depressive disorder, the computer would automatically reclassify it to the broader, less-serious diagnosis of “depression, not otherwise stated.” The VA said it expects to fix this error by early next year.

Nearly one-third of patients examined by investigators were not properly coded as having major depressive disorder. Although that wouldn’t necessarily affect the care of a particular patient, it’s important to have correct information for trends and evaluating programs, the report said.

“The Department of Veterans Affairs agrees that precise and reliable diagnoses are an important guide to veteran treatment planning,” said Gina Jackson, a VA spokeswoman. “VA fully understands that a need exists to ensure that patient data accurately reflects the actual occurrence of clinically diagnosed major depressive disorder among veterans enrolled in VA for health care.”

The report also found that doctors weren’t following best practices in treating most patients. Investigators said they couldn’t determine whether that was harming veterans’ care.

Some examples of deviation from the accepted guidelines include not using a standardized assessment tool to evaluate progress and not following up within the recommended time frame.

Of the 30 patient cases studied by the GAO, one had no planned follow-up and five had follow-ups scheduled outside the six-week recommended window. One didn’t receive a follow-up appointment until nearly a year later, the report found.

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