Introduction: It has been estimated that 15-22% of all Service Members (SMs) have sustained a mild traumatic brain injury (mTBI). Many SMs develop symptoms secondary to this injury, including headaches, cognitive deficits, and changes in mood and behavior. To address these resulting symptoms, SMs often seek additional healthcare services in the Military Health System (MHS). While this increase in demand has been documented, few studies have assessed the cost implications.
Previous research estimating the healthcare costs among those with TBI have generally focused on civilian or veteran populations, with few studies examining healthcare utilization and costs following TBI among service members while still in the military. Additionally, previous studies examining utilization and cost following TBI, generally do not account for the utilizations and costs incurred prior to injury. Without considering prior healthcare use, it can be challenging to evaluate the true impact of mTBI on a healthcare system. This project therefore evaluates the changes in healthcare utilization and cost among a population of active-duty population following an initial mTBI.
Materials and
Methods: This is a retrospective study of electronic health record (EHR) data of active-duty SMs who sustained a first mTBI between 2017 and 2018, as documented within the MHS. Direct care encounter records from care received at military treatment facilities one year before and one year following index date were obtained and analyzed.
EHR metadata, demographics, and accounting information were linked to generate a comprehensive dataset which included encounter details such as patient demographics, Medical Expense Performance Reporting System (MEPRS) codes, and multiple cost allocated variables (e.g., FullCost, FullCost_Pharm, etc.).
Additionally, to better understand the changes in type of care, MEPRS codes were grouped based on similar clinic descriptions (e.g., Mental Health Clinics, Surgical Clinics, etc.). For each SM, total encounter costs were calculated both before and after the index TBI date and with respect to each clinic type. Summary statistics provided estimates in both the changes in healthcare utilization as well as changes in total cost from the year before the TBI diagnosis to the year after in the MHS.
Results: For this analysis, 23,279 active duty SMs met the inclusion criteria. This resulted in a sample population of 80.8% male, with the majority between the ages of 17-24 (45.7%). High representation by race were White, non-Hispanic (58.0%), followed by Black, non-Hispanic (17.7%). Examining military characteristics, 60.4% of the sample population was from the United States Army, while 45.6% were classified as Junior Enlisted.
In total, over 1.2 million encounter records were analyzed, amounting to over $297 million in direct care costs. When examining the changes in healthcare utilization, a 39.9% increase in total encounters was observed from pre-injury to post-injury. In addition, an increase in overall cost was also observed. In total, there was a 38.7% increase in outpatient direct care expenditures in the year following the index TBI.
Evaluating clinic utilizations, the greatest increase was observed among Neurology and Pain, which exhibited a 133% increase, followed by Mental Health (70.1%). The smallest increases in clinic utilization occurred in Emergency Medicine visits (2.9%) followed by General Medicine (8.5%).
Greatest increase in total cost per patient was among Mental Health clinics, with an average change of $916. This was followed by Physical Rehabilitation, with a mean total increase of $423. Despite exhibiting an increase in total encounters, an average total decrease of $443 was observed among Specialty Medicine clinics. A similar trend was observed among Surgical clinics, with an average total decrease of $175.
Conclusion: There has been limited research assessing healthcare expenditures within the MHS specific to mTBI. This study provides one of the first analyses of changes in healthcare utilization and costs in the MHS following an index TBI, revealing that both healthcare utilization and costs increased by almost 40% in the first year following a first mTBI diagnosis. The greatest increases in utilization and costs occurred in Neurology/Pain clinics, Mental Health, and Physical Rehabilitation. Evaluating the changes in healthcare utilization and cost, with regards to specific clinics enables healthcare administrators to better anticipate clinic demands and allocate appropriate resources.
Keywords: TBI, Healthcare Utilization, Cost, Military
