1018 — Three Year Trends in VHA Utilization and Costs Following Screening among Veterans with Deployment-Related Mild Traumatic Brain Injury

Taylor BC, CCDOR, Minneapolis VA Medical Center; Hagel Campbell EM, CCDOR, Minneapolis VA Medical Center; Fletcher LA, CCDOR, Minneapolis VA Medical Center; Nugent S, CCDOR, Minneapolis VA Medical Center; Bidelspach DE, Physical Medicine and Rehabilitation Program Office, Lebanon, PA; Kehle-Forbes SM, CCDOR, Minneapolis VA Medical Center; Scholten JD, Physical Medicine and Rehabilitation Program Office, Washington, D.C.; Sayer NA, CCDOR, Minneapolis VA Medical Center;

Objectives:
To assess the patterns of VHA healthcare utilization and costs over three years following TBI screening for OEF/OIF/OND Veterans diagnosed with mild TBI (mTBI) compared with controls without TBI.

Methods:
We merged national VA datasets on TBI screening and evaluation, healthcare utilization and costs to create a cohort of Veterans identified as having a mTBI in FY2010 through the VA's TBI Screening and Evaluation program (n = 7,326) and a control cohort of those who screened negative for TBI (n = 76,380). Utilization and cost data were calculated for each person in yearly intervals for three years following TBI screening.

Results:
Across all three years, Veterans with mTBI incurred substantially higher outpatient and inpatient utilization compared with Veterans in the control group. The mean number of outpatient appointments was over 2 times higher each year for Veterans with mTBI compared to those without TBI. Inpatient days were also substantially higher in Veterans with mTBI versus controls (mean number of days: 4.8, 3.8 and 3.3 times higher across three years). Higher mental health-related care contributed to more than half of absolute difference in both outpatient and inpatient utilization. Healthcare costs were greatest in the year following screening for both groups. The median cost of care for Veterans with mTBI was $7,146 in the year following screening and $2,310 and $1,900, respectively, in the next two years; Veterans without TBI had median costs of $2,158, $596 and $487 in the three years following screening. A greater proportion of Veterans with mTBI were still using VHA outpatient services in two and three years after screening (84% and 79% for mTBI and 65% and 60% for controls, respectively).

Implications:
Veterans with mTBI are more likely to remain VHA users and use more services over time. Mental health service use appears to drive most of the between group differences. The use of VHA services for all OEF/OIF/OND Veterans decreases dramatically and levels off after the initial year following TBI screening.

Impacts:
Utilization trends among Veterans with mTBI assist in strategic planning for future clinical programming; additional work evaluating the impact of healthcare use on patient outcomes is needed.