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GAO says inaccurate medical records thwarting efforts to prevent veterans’ suicides

The U.S. Government Accountability Office says inaccurate medical records and noncompliance are thwarting efforts to lower suicide rates among veterans.

According to ModernHealthcare.com

“A review of records of 30 patients who were diagnosed with a major depressive disorder and were treated at six Veterans Affairs medical centers found that almost all had received care that deviated from the VA’s own clinical-practice guidelines. The GAO also found that the VA was not properly documenting the diagnosis of many patients because of a software mapping error. The VA said the suicide rate had stabilized but had not dropped after prevention efforts were implemented. It’s estimated that 22 veterans die by suicide each day.”

From the GAO report:

“GAO’s recent work has found that the demographic and clinical data that VA collects on veteran suicides were not always complete, accurate, or consistent. VA’s Behavioral Health Autopsy Program (BHAP) is a quality initiative to improve VA’s suicide prevention efforts by identifying information that VA can use to develop policy to help prevent future suicides. The BHAP templates are a mechanism by which VA collects suicide data from VAMCs’ review of veteran medical records. GAO’s review of the 63 completed BHAP templates at five VAMCs found that (1) over half of the templates that VAMCs submitted to VA had incomplete or inaccurate data, and (2) VAMCs submitted inconsistent information because they interpreted VA’s guidance differently. Lack of complete, accurate, and consistent data—coupled with GAO’s finding of poor oversight of the review of BHAP templates—can inhibit VA’s ability to identify, evaluate, and improve ways to better inform its suicide prevention efforts.

Why GAO Did This Study
In 2013, VA estimated that about 1.5 million veterans required mental health care, including for MDD. MDD is a debilitating mental illness related to reduced quality of life and increased risk for suicide. VA also plays a role in suicide risk assessment and prevention.
This testimony addresses the extent to which (1) veterans with MDD who are prescribed an antidepressant receive recommended care and (2) VAMCs are collecting information on veteran suicides as required by VA. The testimony is based on GAO’s November 2014 report, VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data (GAO-15-55). For that report GAO analyzed VA data, interviewed VA officials, and conducted site visits to six VAMCs selected based on geography and population served. GAO also reviewed randomly selected medical records for five veterans from each of the six VAMCs, for veterans diagnosed with MDD and prescribed an antidepressant in 2012, as well as all completed BHAP templates. The results cannot be generalized across VA. GAO followed up in May 2015 to determine the status of GAO’s previous recommendations.

What GAO Recommends
GAO recommended that VA implement processes to assess deviations from recommended care; identify and address MDD coding issues; and implement processes to improve veteran suicide data. VA has made progress on these recommendations and has fully implemented one.”