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2023 HSR&D/QUERI National Conference Abstract

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4089 — Long Term Outcomes of CIH Therapies in Veterans with TBI

Lead/Presenter: Qing Zeng,  Washington DC VA Medical Center
All Authors: Zeng QT (Washington DC VA Medical Center), Goulet JL (VA Connecticut Healthcare System) Shao Y (Washington DC VA Medical Center) Cheng Y (Washington DC VA Medical Center)

Objectives:
The 2021 VA-DOD guidelines for the management of mild traumatic brain injury (TBI) recommend a symptom-driven patient-centered primary care non-pharmacologic approach and caution against the use of medications. Complementary and Integrative Health (CIH) has emerged as one of the primary non-pharmacologic modes of therapy for Veterans. However, little is known about the impact of CIH on long-term outcomes such as hospitalization and mortality in patients with TBI. There is an urgent need to generate evidence to guide the utilization of CIH for patients with TBI.

Methods:
Utilizing NLP tools developed by our team, we identified CIH use in a randomly selected subset of Veterans with TBI (n = 50,582). For CIH users, the index date was defined as their first CIH treatment date. For non-users, it was an encounter date matching the time since the first TBI diagnosis in a case. We first compared the baseline characteristics of CIH and non-CIH users. We then constructed a Cox proportional hazards model to estimate the hazard ratio and confidence interval for mortality associated with CIH use, using age, gender, race, ethnicity, healthcare utilization, and Charlson Comorbidity Index as covariates.

Results:
We found that 31.2% of the patients with TBI received at least one CIH modality with an average length of follow-up of 5.8 and 5.5 years for CIH and non-CIH users, respectively. The CIH users were younger (47.4 vs. 52.9 years of age), with a higher percentage of females (11.0% vs. 7.5%) and African Americans (18.1% vs. 15.0%). The CIH users had about twice as many visits (25 vs. 14) and three times the admission rates (38.4% vs. 11.1%) compared to the non-CIH users before the index date. During follow-up, the CIH users had a much lower 1-year mortality rate (2.3% vs. 4.2%). The average number of all admissions per 100 persons per year after the index date in the CIH group was lower than that of the non-CIH group during the long-term follow-up (12.0 vs. 14.2). In the Cox regression analysis, the use of CIH was favorably associated with long term survival (HR: 0.64 (0.59-0.70), p < 0.0001).

Implications:
Even though CIH appears to be often reserved for the “sicker” patients, CIH use is associated with a significantly lower risk of long-term mortality.

Impacts:
Our finding on the long-term benefits of CIH provides new evidence in support of the expansion of the Whole Health program in VA, especially in the TBI population.