1045 — Healthcare Utilization and Costs of Veterans Screened for Traumatic Brain Injury
Stroupe KT, Evans CT, Hogan TP, St. Andre JR, Huo Z, and Smith BM, Hines VA Hospital;
Approximately 16% of casualties in the OEF/OIF conflicts have had mild traumatic brain injury (TBI). To identify Veterans who may benefit from treatment, VA implemented a national clinical reminder (CR) in 2007 to screen for mild TBI. Veterans who screen positive are referred for comprehensive TBI evaluation. We assessed the annual healthcare utilization and costs of Veterans following screening for mild TBI.
We conducted a national retrospective study of OEF/OIF Veterans receiving care at VA facilities from 2007-2008. We identified OEF/OIF Veterans from VA’s National OEF/OIF roster. Mild TBI CR screening data were obtained from the VA National TBI Health Factors database, which is managed by the VA Office of Patient Care Services. Healthcare utilization and costs were obtained from VA Medical SAS Inpatient and Outpatient datasets and DSS National Data Extracts. We examined the association of the TBI CR screen with healthcare utilization and costs over a 12-month period following the CR screening (or the first VA healthcare utilization after April 14, 2007 for Veterans without CR screening), using multivariable regression analyses that controlled for patient and facility characteristics and clustering of patients within facilities.
There were 170,681 Veterans meeting inclusion criteria: 14,266 without CR screening, 124,335 screened negative, and 32,080 screened positive. Veterans who screened positive had significantly more outpatient visits during 12 months following the initial evaluation. Outpatient costs for Veterans who had no CR screening, screened negative, or screened positive averaged $3,112, $4,522, and $6,570 (P <0.001), respectively. Veterans who screened positive had more inpatient days for acute and mental healthcare than other screening groups. Inpatient costs averaged $674, $848, and $1,067 (P <0.001), and total costs averaged $3,992, $5,680, and $8,081 (P <0.001) for Veterans who had no CR screening, screened negative, or screened positive, respectively.
Over 12 months following their initial evaluation, Veterans screening positive on the CR had >40% higher total costs than Veterans who screened negative and more than double the total costs of Veterans with no CR screening.
Understanding healthcare utilization and cost patterns following CR screening is important for policymakers as they address the ongoing and future healthcare needs of returning OEF/OIF Veterans.