Data Scientist National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center
Abstract Text:
Background: Due to recent military operations, traumatic brain injury (TBI) emerged as a signature wound of these wars. According to the most recent report from the Traumatic Brain Injury Center of Excellence (TBICoE), since 2000, more than 444,000 TBIs have been diagnosed, with the majority being classified as mild (TBICoE, 2001). Research has shown that TBI is associated with different health outcomes, including impairment in one or more of the following domains: physical, cognitive, behavioral, and psychological (Institute of Medicine, 2012, 2014). The persistent symptoms following TBI are commonly referred to as post-concussive symptoms (PCS) (Baldassarre et al., 2015; Lange et al., 2014). Over time different treatments have been developed to address PCS associated with TBI. The National Intrepid Center of Excellence (NICoE), the TBI Directorate at Walter Reed National Military Medical Center (WRNMMC) in Bethesda developed an interdisciplinary intensive outpatient program (IOP) to treat service members (SMs) suffering from persistent concussive symptoms from combat- and mission-related mild TBI (mTBI) (De Graba et al., 2021). The uniqueness of this four-week interdisciplinary IOP is the combination of traditional rehabilitation, neurological, and behavioral health treatments with integrative medicine interventions and skills-based training to improve SMs recovery, whose progress has plateaued. While previous research has supported the impact of IOPs on patient outcomes, limited research has assessed the impact of the IOP on the military health system (MHS). The purpose of the current study is to indirectly examine the NICoE IOP's impact on healthcare utilization following participation in this program. Specifically to identify distinct latent groups based on healthcare utilization changes within a year of completing the IOP program. Additionally, to better understand the SMs that may need further treatment, demographic and military characteristics were examined to determine differences among the latent groups.
Materials and
Methods: This is a retrospective study of electronic health record (EHR) data of 1,168 active-duty SMs who have attended the NICoE 4-week interdisciplinary IOP. Latent growth curve models (LGCM) were employed to identify unobserved groups based on changes in clinic utilization following discharge from the IOP. Multinomial logistic regression further assisted in evaluating latent group characteristics and assessing any demographic differences among classes.
Results: Of the 1,168 active duty SMs, the majority were male (98.5%), White (74.8%), ranged in age between 22 to 59 years old (M = 39.5, SD = 6.3), married (81.2%), and with an average of 14.5 years of education. All branches of the military were included in this study, with the majority of the sample being sailors (59.8%), enlisted (77.1%), and belonging to a Special Forces group (70.4%), with an average of 18.7 years in the military.Based upon model fit indices, a five-class model solution provided optimal fit. Examining the changes in clinic utilization, distinctions among these groups can be made. The majority of SMs (57.8%) were grouped within the Low Utilizers class, followed by the Moderate Utilizers class (17%), the Mental Health and General Medicine class (11.5%), the Mental Health class (7.1%), and the Specialty Medicine class (6.7%).Examining the results of the multinomial logistic regression, differences among those likely to be Low Utilizers emerged in demographic and military variables (p < 0.05).
Discussion: The development of highly effective treatments for combat- and mission-related mild TBI continue to be a high priority. This study highlights the ongoing need to understand TBI in the military and, more importantly, understand individuals whose recovery from TBI does not happen within the expected time of a few weeks to months.Findings from this study may also provide guidance not only to anticipate healthcare needs, but also to identify SMs who may likely require additional follow-up services.
Keywords: TBI, Health Care Utilization, Military, Intensive Outpatient Program, Mental Health
