Addison L. Kimber

This cross-sectional study compared patient satisfaction with headache care in Veterans Health Administration (VHA) Headache Centers of Excellence (HCoE) and HCoE facilities versus traditional headache care. Using the VHA Survey of Healthcare Experiences of Patients specialty care survey, we analyzed responses from 4317 (14% response rate) veterans with a VHA headache visit who received care from (1) a Veterans Affairs (VA) HCoE provider; (2) a non-HCoE provider within a VA medical center containing an HCoE; or (3) a provider in a VA medical center without an HCoE. Compared to patients at non-HCoE facilities, both HCoE patients and HCoE facility patients reported higher overall satisfaction with their VHA care in general (OR = 1.32, 95% CI = 1.05-1.64; OR = 1.46, 95% CI = 1.38-1.54), respectively. Despite a modest response rate, HCoE and HCoE facility patients reported significantly higher satisfaction across other domains including access and communication, in models adjusting for demographics. These findings advance the conversation regarding the value of HCoEs in delivering high-quality, patient-centered care and expanding HCoE resources may improve satisfaction. Future research should formally investigate methods of improving satisfaction.

Background and Objectives To determine gender differences in headache types diagnosed, sociodemographic characteristics, military campaign and exposures, and health care utilization among US veterans in the Veterans Health Administration (VHA). Methods This study used a retrospective cohort design to examine VHA electronic health record (EHR) data. This cohort includes veterans who had at least 1 visit for any headache between fiscal years 2008 and 2019. Headache diagnoses were classified into 8 categories using International Classification of Disease, Clinical Modification codes. Demographics, military-related exposures, comorbidities, and type of provider(s) consulted were extracted from the EHR and compared by gender. Age-adjusted incidence and prevalence rates of medically diagnosed headache disorders were calculated separately for each type of headache. Results Of the 1,524,960 veterans with headache diagnoses included in the cohort, 82.8% were men. Compared with women, men were more often White (70.4% vs 56.7%), older (52.0 ± 16.8 vs 41.9 ± 13.0 years), with higher rates of traumatic brain injury (2.9% vs 1.1%) and post-traumatic stress disorder (23.7% vs 21.7%), and lower rates of military sexual trauma (3.2% vs 33.7%; p < 0.001 for all). Age-adjusted incidence rate of headache of any type was higher among women. Migraine and trigeminal autonomic cephalalgia rates were most stable over time. Men were more likely than women to be diagnosed with headache not otherwise specified (77.4% vs 67.7%) and have higher incidence rates of headaches related to trauma (3.4% vs 1.9% [post-traumatic]; 5.5% vs 5.1% [postwhiplash]; p < 0.001 for all). Men also had fewer headache types diagnosed (mean ± SD; 1.3 ± 0.6 vs 1.5 ± 0.7), had fewer encounters for headache/year (0.8 ± 1.2 vs 1.2 ± 1.6), and fewer visits to headache specialists (20.8% vs 27.4% p < 0.001 for all), compared with women. Emergency department utilization for headache care was high for both genders and higher for women compared with men (20.3% vs 22.9%; p < 0.001). Discussion Among veterans with headache diagnoses, important gender differences exist for men and women veterans receiving headache care within VHA regarding sociodemographic characteristics, headache diagnoses, military exposure, and headache health care utilization. The findings have potential implications for providers and the health care system caring for veterans living with headache.