Review of Clinical Care Transition from the Department of Defense to the Veterans Health Administration for Service Members with Opioid Use Disorder

The VA Office of Inspector General (OIG) conducted a national review evaluating the transition of clinical care for service members with opioid use disorder (OUD) from the Department of Defense (DoD) to the Veterans Health Administration (VHA). OUD is an established risk factor for opioid overdose death and suicide. Failure to identify and document a patient’s OUD history may decrease the likelihood of future providers using medically relevant information in clinical decision-making and may put patients at risk for adverse outcomes, such as overdose. The OIG conducted electronic health record reviews for two groups identified from a sample of discharged service members with an OUD diagnosis documented in the DoD treatment record, who had a VHA primary care or mental health encounter between the date of DoD discharge and July 4, 2021. Group 1 consisted of patient records without an OUD diagnosis in VHA data and group 2 consisted of patients with an opioid-related death. Deficiencies were found in VHA primary care and mental health providers’ documentation identifying OUD in encounters, progress notes, and problem lists for both study groups reviewed, despite having a diagnosis of OUD in DoD treatment records. The OIG evaluated provider perceptions of barriers documenting OUD and use of risk mitigation strategies. More than half of VHA providers who responded to a questionnaire reported no expectation of reviewing DoD treatment records when completing an intake and identified barriers reviewing DoD treatment records. The OIG made five recommendations to the VA Under Secretary for Health related to the identification of barriers for providers documenting OUD in electronic health records; training on the use, navigation, and retrieval of DoD treatment record information; evaluation of the barriers to access and use of DoD treatment records; and evaluating and updating processes for the identification of patients with OUD.