Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Thomas T. H. Wan


Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients

even decades after the occurrence of traumatic events. The “health behavioral model” is

adopted to examine the effects of external environmental, predisposing, enabling, and

need for care factors on the use of VA post-discharge ambulatory care and readmissions.

Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File

(OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR).

The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6).

In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care.

For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs.

The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans.

The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings.

Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


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VCU University Archives

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VCU Theses and Dissertations

Date of Submission