TY - JOUR
T1 - Health Services Utilization, Health Care Costs, and Diagnoses by Mild Traumatic Brain Injury Exposure
T2 - A Chronic Effects of Neurotrauma Consortium Study
AU - Dismuke-Greer, Clara
AU - Hirsch, Shawn
AU - Carlson, Kathleen
AU - Pogoda, Terri
AU - Nakase-Richardson, Risa
AU - Bhatnagar, Saurabha
AU - Eapen, Blessen
AU - Troyanskaya, Maya
AU - Miles, Shannon
AU - Nolen, Tracy
AU - Walker, William C.
N1 - Funding Information:
Supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium (award no. W81XWH-13-2-0095 ). The U.S. Army Medical Research Acquisition Activity, 820 Chandler St, Fort Detrick, MD 21702-5014, is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.
Funding Information:
Supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium (award no. W81XWH-13-2-0095). The U.S. Army Medical Research Acquisition Activity, 820 Chandler St, Fort Detrick, MD 21702-5014, is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.
Publisher Copyright:
© 2020
PY - 2020/10
Y1 - 2020/10
N2 - Objective: To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs non–blast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study. Design: Prospective cohort study. Setting: Four Veterans Affairs Medical Centers. Participants: OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017. Interventions: Not applicable. Lifetime mTBI history was assessed via semistructured interviews. Main Outcome Measures: VHA diagnoses, health services utilization, and costs. Results: Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864). Conclusions: Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.
AB - Objective: To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs non–blast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study. Design: Prospective cohort study. Setting: Four Veterans Affairs Medical Centers. Participants: OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017. Interventions: Not applicable. Lifetime mTBI history was assessed via semistructured interviews. Main Outcome Measures: VHA diagnoses, health services utilization, and costs. Results: Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864). Conclusions: Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.
KW - Brain injuries
KW - Costs and cost analysis
KW - Rehabilitation
KW - Traumatic
KW - Veterans
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U2 - 10.1016/j.apmr.2020.06.008
DO - 10.1016/j.apmr.2020.06.008
M3 - Article
C2 - 32653582
AN - SCOPUS:85089176138
VL - 101
SP - 1720
EP - 1730
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 10
ER -