Investigator Insights: The Intersection of Precision Medicine and Health Disparities

Investigator Insights: The Intersection of Precision Medicine and Health Disparities


My name is Emily Brignone, I’m affiliated with the Informatics,
Decision-Enhancement, and Analytic Sciences Center
at VA Salt Lake City, and I’m also an incoming Health
Services Research Post-Doctoral Fellow at the Center for Health
Equity Research and Promotion at VA Pittsburgh. Precision Medicine is a medical
model that emphasizes the tailoring of healthcare decisions and practices and services to unique and individual patient needs. Precision medicine is usually thought of in terms of things like biomarkers in genes, but at the VA, we have the opportunity
to extend this approach to include a focus on a broader range
of factors that are related to health. So, this can include things
like military service experiences, and exposures during military service, as well as certain
social determinants of health. The VA serves are really diverse
population of Veterans, not only in terms of demographics, but in terms of experiences in the military, and unique health risks
and health related needs. In terms of the most recent
cohort of Veterans who have returned form
conflicts in Iraq and Afghanistan, some of them come home from service and transition into
civilian life just fine and don’t really have many issues. But there are others who
do encounter certain challenges, and these can include challenges that are related to physical
and mental health, or employment issues, or family issues,
or economic issues. In order to be responsive
to these issues, and really meet their needs,
we have to engage them in care that is responsive
to those specific needs. In doing so, we can help to mitigate
some of the health disparities that we see among this population. We’ve recently learned that Veterans who are discharged from service for reasons that aren’t routine— so reasons other than expiration
of term of service or retirement— these Veterans tend to be vulnerable to a range of adverse outcomes
in the post-deployment period. And among Veterans of recent
conflicts in Iraq and Afghanistan, about 30 percent are discharged
under these non-routine conditions, and the most common
reason for this is disability. And this can be physical, health issues or mental health issues, but they were severe enough
that the service member was unable to continue
in the line of duty and they were discharged. Many of these Veterans
make their way to the VA following their discharge
from service, and they receive health
services treatment and many of them also receive
service-connected disability benefits, and these benefits are intended
to offset any income that my have been lost as a result of these disabilities
that were related to their service. And what we’ve found is that although
many of theses service members who were discharged due to disability are receiving these service-connected
disability benefits, they’re actually at a higher risk
for homelessness in the post-deployment period. And so while we found that there was
some protection offered by the service-connected
disability benefits, it doesn’t fully mitigate the risk that’s associated with being
discharged due to disability. We’ve learned form
these recent studies that it seems that we need to
pay more attention to their long-term needs, because results from
this study indicate that when they first
return home from service, they seem to be doing okay, and their risk for
homelessness isn’t any higher than those who were discharged
under routine conditions, but as time goes on, their risk for homelessness
increases and increases. So we need to be responsive
to maybe the changing needs associated with disability over time. There are several things that
I really like about the VA. One is how interdisciplinary
the environment is. I regularly have the opportunity to collaborate with experts from across
this wide range of domains, so I work with clinicians, and programmers, and statisticians, and mathematicians,
and fellow social scientists, and it really results in
this rich and stimulating environment with so many fresh new ideas. Another thing that I like
about VA research is the emphasis on translating
research findings into practice. There’s a lot of research
where that piece is overlooked, but that’s not at all true at VA,
and this is evidenced in the strong culture of collaboration
between researchers and clinical and operational partners. So it really is a privilege to be
engaged in this public service and to continue to work towards that goal of providing the
best possible services to those who have served
and given so much.

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