Three Year Trends in Veterans Health Administration Utilization and Costs after Traumatic Brain Injury Screening among Veterans with Mild Traumatic Brain Injury

Abstract

Examination of trends in Veterans Health Administration (VHA) healthcare utilization and costs among veterans with mild traumatic brain injury (mTBI) is needed to inform policy, resource allocation, and treatment planning. The objective of this study was to assess the patterns of VHA healthcare utilization and costs in the 3 years following TBI screening among veterans with mTBI, compared with veterans without TBI. A retrospective cohort study of veterans who underwent TBI screening in fiscal year 2010 was conducted. We used VHA healthcare utilization and associated costs by categories of care to compare veterans diagnosed with mTBI (n = 7318) with those who screened negative (n = 75,294) and those who screened positive but had TBI ruled out (n = 3324). Utilization and costs were greatest in year 1, dropped in year 2, and then leveled off. mTBI diagnosis was associated with high rates of utilization. Each year, healthcare costs for those with mTBI were two to three times higher than for those who screened negative, and 20–25% higher than for those who screened positive but had TBI ruled out. A significant proportion of healthcare use and costs for veterans with mTBI were associated with mental health service utilization. The relatively high rate of VHA utilization and costs associated with mTBI over time demonstrates the importance of long-term planning to meet these veterans' needs. Identifying and engaging patients with mTBI in effective mental health treatments should be considered a critical component of treatment planning.

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References

Gawande

(2004). Casualties of war – military care for the wounded from Iraq and Afghanistan. N. Engl. J. Med., 351, 2471–2475.

Okie

(2005). Traumatic brain injury in the war zone. N. Engl. J. Med., 352, 2043–2047.

Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine (1993). Definition of mild traumatic head injury. J. Head Trauma Rehabil., 8, 86–87.

Department of Veterans Affairs and Department of Defense (2016). VA/DoD clinical practice guideline for the management of concussion/mild traumatic brain injury (mTBI). Available at: http://www.healthquality.va.gov/guidelines/Rehab/mtbi/. Accessed April 13, 2017 .

Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control Prevention, Department of Health and Human Services (2014). Report to congress on traumatic brain injury in the United States: epidemiology and rehabilitation. Available at: http://www.cdc.gov/traumaticbraininjury/pdf/tbi_report_to_congress_epi_and_rehab-a.pdf. Accessed April 13, 2017 .

Defense and Veterans Brain Injury Center. (2016). TBI Basics. Silver Spring, MD. Available at: https://dvbic.dcoe.mil/about-traumatic-brain-injury/article/tbi-basics. Accessed April 13, 2017 .

Ruff

R.M.

, Camenzuli

, and Mueller

(1996). Miserable minority: emotional risk factors that influence the outcome of a mild traumatic brain injury. Brain Inj. 10, 551–565.

Vanderploeg

R.D.

, Curtiss

, Luis

C.A.

, and Salazar

A.M.

(2007). Long-term morbidities following self-reported mild traumatic brain injury. J. Clin. Exp. Neuropsychol., 29, 585–598.

Pertab

J.L.

, James

K.M.

, and Bigler

E.D.

(2009). Limitations of mild traumatic brain injury meta-analyses. Brain Inj. 23, 498–508.

10.

Veterans Health Administration, U.S. Department of Veterans Affairs (2010). Screening and Evaluation of Possible Traumatic Brain Injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans: VHA Directive 2010–012. Washington, DC.

11.

Sayer

N.A.

(2012). Traumatic brain injury and its neuropsychiatric sequelae in war veterans. Annu. Rev. Med., 63, 405–419.

12.

Stroupe

K.T.

, Smith

B.M.

, Hogan

T.P.

, St Andre

J.R.

, Pape

, Steiner

M.L.

, Proescher

, Huo

, and Evans

C.T.

(2013). Healthcare utilization and costs of veterans screened and assessed for traumatic brain injury. J. Rehabil. Res. Dev., 50, 1047–1068.

13.

McCrea

M.A.

(2008). Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment. Oxford University Press: New York.

14.

O'Neil

M.E.

, Carlson

K.F.

, Storzbach

, Brenner

, Freeman

, Quinones

, Motu'apuaka

, Ensley

, and Kansagara

(2012). Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. VA-ESP Project #05-225. Washington, DC: U.S. Department of Veterans Affairs.

15.

Wagner

T.H.

, Chen

, and Barnett

P.G.

(2003). Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA. Med. Care Res. Rev., 60, 15S–36S.

16.

Phibbs

C.S.

, Barnett

P.G.

, and Fan

(2015). Research Guide to the Managerial Cost Accounting National Cost Extract. VA Palo Alto, Health Economics Resource Center of Health Service R&D Services, Department of Veterans Affairs: Menlo Park, CA.

17.

Taylor

B.C.

, Campbell

, Nugent

, Fletcher

, Bidelspach

D.E.

, Kehle- Forbes

S.M.

, Stroupe

K.T.

, Scholten

, and Sayer

N.A.

(2015). Fiscal year 2014 VA utilization report for Iraq and Afghanistan War veterans diagnosed with TBI. Prepared for the VA Polytrauma and Blast-Related Injuries QUERI #PLY 05-2010-2. Available at: http://www.polytrauma.va.gov/TBIReports/FY14-TBI-Diagnosis-HCU-Report.pdf. Accessed April 13, 2017 .

18.

Eibner

, Ringel

J.S.

, Kilmer

, Pacula

R.L.

, and Diaz

(2008). The cost of post-deployment mental health and cognitive conditions, in: Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Tanielian

, and Jaycox

L.H.

(eds.). Santa Monica, CA: RAND, pps. 169–241.

19.

Hodgkinson

, Veerabangsa

, Drane

, and McCluskey

(2000). Service utilization following traumatic brain injury. J. Head Trauma Rehabil., 15, 1208–1226.

20.

Cameron

C.M.

, Purdie

D.M.

, Kliewer

E.V.

, McClure

R.J.

(2008). Ten-year outcomes following traumatic brain injury: a population-based cohort. Brain Inj. 22, 437–449.

21.

Taylor

B.C.

, Hagel

E.M.

, Carlson

K.F.

, Cifu

D.X.

, Cutting

, Bidelspach

D.E.

, and Sayer

N.A.

(2012). Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Iraq and Afghanistan veteran VA users. Med. Care, 50, 342–346.

22.

Hendricks

, Krengel

, Iverson

K.M.

, Kimerling

, Tun

, Amara

, and Lew

H.L.

(2012). Estimating the costs of care, in: PTSD and Mild Traumatic Brain Injury. Vasterling

, Bryant

, and Keane

(eds.). Guilford Press: New York, pps. 260–281.

23.

Belanger

, Vanderploeg

, and Sayer

N.A.

(2016). Screening for remote history of mild TBI in VHA: a review of the literature. J. Head Trauma Rehabil., 31, 204–214.

24.

Polusny

M.A.

, Kehle

S.M.

, Nelson

N.W.

, Erbes

C.R.

, Arbisi

P.A.

, and Thuras

(2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in National Guard soldiers deployed to Iraq. JAMA Psychiatry, 68, 79–89.

25.

Carlson

K.F.

, Kehle

, Meis

L.A.

, Greer

, Macdonald

, Rutks

, Sayer

N.A.

, Dobscha

S.K.

, and Wilt

TJ.

(2011). Prevalence, assessment, and treatment of mild traumatic brain injury and post-traumatic stress disorder: a systematic review of the evidence. J. Head Trauma Rehabil., 26, 103–115.

26.

Bryant

R.A.

, O'Donnell

M.L.

, Creamer

, McFarlane

A.C.

, Clark

C.R.

, and Silove

(2010). The psychiatric sequelae of traumatic injury. Am. J. Psychiatry, 167, 312–320.

27.

Donnelly

K.T.

, Donnelly

J.P.

, Dunnam

, Warner

G.C.

, Kittleson

C.J.

, Constance

J.E.

, Bradshaw

C.B.

, and Alt

(2011). Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool. J. Head Trauma Rehabil., 26, 439–453.

28.

Kehle-Forbes

S.M.

, Campbell

E.H.

, Taylor

B.C.

, Scholten

, and Sayer

(2017). Does co-occurring traumatic brain injury affect VHA outpatient health service utilization and associated costs among veterans with posttraumatic stress disorder?. An examination based on VHA administrative data. J. Head Trauma Rehabil., 32, E16–E23.

29.

Sripada

R.K.

, Rauch

S.A.M.

, Tuerk

P.W.

, Smith

, Defever

A.M.

, Mayer

R.A.

, Messina

, and Venners

(2013). Mild traumatic brain injury and treatment response in prolonged exposure for PTSD. J. Trauma Stress, 26, 369–375.

30.

Chard

K.M.

, Schumm

J.A.

, McIlvain

S.M.

, Bailey

G.W.

, and Parkinson

R.B.

(2011). Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury. J. Trauma Stress, 24, 347–351.

31.

Epidemiology Program, Post-Deployment Health Group, Office of Public Health, Veterans Health Administration, Department of Veterans Affairs (2015). Analysis of VA health care utilization among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans: Cumulative from 1st Qtr FY 2002 through 2nd Qtr FY 2015 (October 1, 2001–March 31, 2015). Washington, DC. Available at: http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2015-qtr2.pdf. Accessed April 13, 2017 .

32.

Veterans Access, Choice, and Accountability Act of 2014. Public Law 113–146 (H.R. 3230).

33.

Corrigan

J.D.

, Hammond

F.M.

(2013). Traumatic brain injury as a chronic health condition. Arch. Phys. Med. Rehabil., 94, 1199–1201.

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