A Retrospective Study of Service Members Enrolled in the Warrior Care and Transition Program

Throughout the campaigns in Iraq and Afghanistan, the Army has been determined to improve the health, welfare, and preparedness of wounded soldiers. The Warrior Care and Transition Program (WCTP) was established in 2004 and subsequently expanded and formalized in 2007 to serve as a comprehensive clinical rehabilitation program for the U.S. Army’s ill and/or injured soldiers. The primary focus of the WCTP is to fulfill the Army’s goal of enhancing wounded soldiers’ transitions back into the fighting force or into a veteran’s status, with full reintegration into the community. Since the WCTP’s inception in 2004, more than 77,000 soldiers have transitioned through the WCTP, and over 30,000 have returned to military duty. The program is designed to provide robust social and clinical care to active and reserve soldiers who require significant support, including case management, social work, and/or transition assistance. While entrance criteria have changed over the duration of the WCTP program, soldiers are generally required to have complex medical needs that will require significant care for a period of at least 3-6 months.

To meet the goal of comprehensive care, warrior transition units (WTU) integrate a diverse staff of primary care physicians, nurse case managers, rehabilitation specialists (OT/PT), social workers, counselors, and others. In addition to assistance with soldier transition, WTU programs also offer mental health and occupational therapy programs (Erickson, 2008). Coordinating efforts across all staff members is important to ensure the delivery of quality patient care. Recently, the Recovering Warrior Task Force, established by Congress in 2010, evaluated DoD wounded warrior services across the military. They synthesized 87 recommendations, which included efforts to better coordinate continuity of care in ways such as integrating IT systems and implementing more user-friendly electronic health records. At WTUs, a large amount of attention is placed on properly managing each patient’s electronic health record to maintain compliance.

WTU patient populations have changed in response to the nature of modern warfare and its intrinsic risks. As the needs of the Army and active combat operations have evolved over the past 10 years, the types of injuries and illnesses sustained by soldiers entering the WCTP have also changed, with the majority of entrants now falling into a disease NBI category. At present, there are fourteen WTUs co-located with MTFs, which reflects a >40% reduction in WTUs from the height of the program. Although military operations in Iraq and Afghanistan have declined significantly, resulting in fewer wounded warriors returning home and a decline of the WCTP population (currently around 2,600 soldiers), the Army is committed to supporting and caring for transitioning soldiers and their families, and remains flexible to changes in the future population.

To the best of our knowledge, this is the first study of its kind to characterize the patient population within the WCTP. Despite the WCTP’s focus on effectively coordinating efforts, there has been minimal systematic research on the WCTP, and the potential exists to identify relevant trends and anomalies that may inform decision-makers within the medical command (MEDCOM) and WCTP. Certain patterns and anomalies may even prove relevant to other military medical efforts and highlight clinical gaps. There are several large, well-maintained databases that track WCTP patients and are available for records-based research (provided the requisite data use agreements and institutional oversight), but this must be evaluated by MIRROR.