On April 13th, the House Armed Services Committee, Subcommittee on Military Personnel held a hearing to discuss present and future plans for the Defense Centers of Excellence (DCoE) established in partnership with the VA, academia, and others. The DCoE are leading efforts to improve the prevention, diagnosis, training, outreach, and direct care for those with TBI and psychological health conditions.
The DCoE have six component centers to provide care, support training, and to advance science to include:
• The Defense and Veterans Brain Injury Center (DVBIC)
• The National Intrepid Center of Excellence (NICoE)—Scheduled to open 2010
• The Center for the Study of Traumatic Stress (CSTS)
• The Deployment Health Clinical Center (DHCC)
• The Center for Deployment Psychology (CDP)
• The National Center for Telehealth and Technology (T2)
Charles L. Rice, M.D., President, University of the Health Sciences plus the Assistant Secretary of Defense for Health Affairs, and Acting Director for the TRICARE Management Activity, appeared at the hearing to discuss the current DCoE and to discuss the need for centers to also be available to help service members with vision, hearing, and traumatic extremity injuries and amputations.
As Dr. Rice pointed out the Centers are to:
• Identify and proliferate best practices and help the Defense Department work with clinical centers across the services, VA, and the civilian sector and to be able to identify and communicate best clinical practices throughout the medical community. For example, TATRC’s Community-Based Warrior Transition Units have explored mobile care protocols for personal telerehabilitation by using cell phones to help with TBI
• Prioritize the Defense medical research agenda and lead efforts to identify gaps in scientific knowledge on wounds, injuries, and diseases, as well as prioritize and coordinate research efforts to fill the gaps. Nearly $50 million in funding is directed to further research to study PTSD brain tissue, the impact of blast physics on brain tissue, and to study advance technologies such as virtual reality, avatars, videogames, telehealth and in other areas
• Enhance patient-centered care and integrate services across the continuum of care by establishing disease registry functions based upon the clinical data repository. So far, call centers and web sites have been established. A registry used by both DOD and the VA is in place to facilitate case management, support longitudinal care, and assess outcomes
Through The National Center for Telehealth and Technology (T2), efforts are being made to standardize DOD telehealth services for psychological health and TBI by establishing a Federal Partners Exploratory Committee on telemental health. DCoE has recently begun serving as a coordinating and resource center for the emerging telehealth network of systems across DOD.
T2 efforts are establishing a collaborative network to help rural and underserved locations by connecting various rural patients with treatment facilities via telehealth technologies that includes web-based applications.
The DCoE coordinated and developed TRICARE’s web-based assistance program (TRIAP) launched in 2009. TRIAP offers counseling assistance by video, and is available 24/7 to active duty and family members as well as to TRICARE reserve select enrollees.
According to Dr. Rice although the Vision Center of Excellence, the Hearing, and the Traumatic Extremity Injuries and Amputations Centers of Excellence were directed by Congress to be established, the initial activities have not developed as expected. However, significant progress on these centers has been made during the past several months.
Dr. Rice is monitoring three significant milestones for 2010. For example, in the coming weeks decisions will be made on how to integrate DCoE operations and share resources with the VA will be put in place. He is going to approve the CONOPS for the three newest Centers in 2010, and the NICoE will open this year with a state-of-the-art facility.
