French D (James Haley VAMC), Bass E
(James Haley VAMC), Scott S
(James Haley VAMC)
We analyzed healthcare use among 62 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) wounded in combat and treated at the Polytrauma Rehabilitation Center (PRC) at the Tampa VA in fiscal years 2005 and 2006 to determine the effect of functional status at initial discharge from the Tampa VA on subsequent resource utilization and associated costs to the VA.
We used the VA Decision Support System National Data Extracts to obtain our data. Functional status at discharge was measured in Functional Independence Measure (FIM) scores which are widely used to determine disability and rehabilitation outcomes. FIM scores were recorded initially at admission to the PRC and averaged a composite score of 80 (Std Dev: 32). Fifty of the 62 patients (61males; 1female) had inpatients stays in 2005-2006 at a total cost to the VA of $4.44 million (mean: $89k; SD $126k). All 62 required outpatient services totaling $1.13 million (mean: $18k; SD $28k). We used cost as a proxy for healthcare utilization in the final analysis.
Regression analysis was conducted to analyze the effect of functional status (composite FIM scores) on total cost of care provided after adjusting for a diagnosis of traumatic brain injury (TBI) and inpatient admission, if any. Multivariate analysis revealed that a one point increase in FIM score on average resulted in a decrease in total costs of subsequent healthcare utilization by $2.4k (p < 0.01). As expected, inpatient stay increased total costs by $102K (p < .01) and a diagnosis of TBI contributed approximately $11K to the same. Model fit was confirmed with an adjusted R-squared=0.53.
Our limited analysis clearly indicates that intensive therapy during hospital stays influences subsequent rehabilitation utilization and cost to the VA. Future studies using more extensive data need to investigate optimal and cost effective discharge strategies for combat wounded veterans.
This study represents one of the first VA research efforts on studying the trajectory of rehabilitation from bedside to community care for OIF/OEF casualties. With increasing numbers of wounded arrivals in VA facilities this effort is a first step in understanding cost effective rehabilitation pathways for servicemen/women wounded in combat.