Monitoring the Well-being of Veterans: A Veteran Well-being Surveillance Framework
Abstract: This paper documents the development of the first iteration of the Veterans’ Well-being Surveillance Framework, which is a joint initiative of the Strategic Policy and Research Directorates. This framework provides ongoing, systematic assessment and surveillance to monitor and measure Veteran well-being. An accepted set of high-level indicators has been identified and will be used to paint a picture of how the Veteran population is doing across multiple facets of life, or domains of well-being. Over time, analysis of the indicators will allow Veterans Affairs Canada to understand trends, areas where Veterans are facing challenges, and where gaps exist. This evidence-informed surveillance will then inform the Department’s policy priorities.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P