Hoover Peter, Adirim-Lanza Andrew, Adams Rachel Sayko, Dismuke-Greer Clara E, French Louis M, Caban Jesus
National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland (Messrs Hoover and Adirim-Lanza and Drs French and Caban); Division of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts (Dr Adams); VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, Colorado (Dr Adams); Health Economics Resource Center (HERC), VA Palo Alto Healthcare System, Palo Alto, California (Dr Dismuke-Greer); and Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr French).
J Head Trauma Rehabil. 2023;38(5):368-379. doi: 10.1097/HTR.0000000000000857. Epub 2023 Feb 28.
To evaluate changes in healthcare utilization and cost following an index mild traumatic brain injury (mTBI) diagnosis among service members (SMs). We hypothesized that differences in utilization and cost will be observed by preexisting behavioral health (BH) diagnosis status.
Direct care outpatient healthcare facilities within the Military Health System.
A total of 21 984 active-duty SMs diagnosed with an index mTBI diagnosis between 2017 and 2018.
This retrospective study analyzed changes in healthcare utilization and cost in military treatment facilities among SMs with an index mTBI diagnosis. Encounter records 1 year before and after mTBI were assessed; preexisting BH conditions were identified in the year before mTBI.
Ordinary least squares regressions evaluated difference in the average change of total outpatient encounters and costs among SMs with and with no preexisting BH conditions (eg, posttraumatic stress disorder, adjustment disorder). Additional regressions explored changes in utilization and cost within clinic types (eg, mental health, physical rehabilitation).
There was a 39.5% increase in overall healthcare utilization during the following year, representing a 34.8% increase in total expenditures. Those with preexisting BH conditions exhibited smaller changes in overall utilization (β, -4.9; [95% confidence interval (CI), -6.1 to -3.8]) and cost (β, $-1873; [95% CI, $-2722 to $-1024]), compared with those with no BH condition. The greatest differences were observed in primary care clinics, in which those with prior BH conditions exhibited an average decreased change of 3.2 encounters (95% CI, -3.5 to -3) and reduced cost of $544 (95% CI, $-599 to $-490) compared with those with no prior BH conditions.
Despite being higher utilizers of healthcare services both pre- and post-mTBI diagnosis, those with preexisting BH conditions exhibited smaller changes in overall cost and utilization. This highlights the importance of considering prior utilization and cost when evaluating the impact of mTBI and other injury events on the Military Health System.
评估现役军人（SM）首次轻度创伤性脑损伤（mTBI）诊断后医疗服务利用情况和成本的变化。我们假设，根据既往行为健康（BH）诊断状况，会观察到医疗服务利用和成本存在差异。
军事卫生系统内的直接护理门诊医疗设施。
2017年至2018年间共有21984名现役军人被诊断为首次mTBI。
这项回顾性研究分析了被诊断为首次mTBI的现役军人在军事治疗机构中的医疗服务利用和成本变化。评估了mTBI前后1年的就诊记录；在mTBI前1年确定既往BH状况。
普通最小二乘法回归评估了有和没有既往BH状况（如创伤后应激障碍、适应障碍）的现役军人在门诊总就诊次数和成本平均变化方面的差异。额外的回归分析探讨了不同诊所类型（如心理健康、身体康复）内的医疗服务利用和成本变化。
次年总体医疗服务利用率增加了39.5%，总支出增加了34.8%。与没有BH状况的军人相比，有既往BH状况的军人在总体利用率（β，-4.9；[95%置信区间（CI），-6.1至-3.8]）和成本（β，-1873美元；[95%CI，-2722美元至-1024美元]）方面的变化较小。在初级保健诊所观察到的差异最大，与没有既往BH状况的军人相比，有既往BH状况的军人平均就诊次数减少3.2次（95%CI，-3.5至-3），成本降低544美元（95%CI，-599美元至-490美元）。
尽管在mTBI诊断前后都是医疗服务的高利用者，但有既往BH状况的军人在总体成本和利用率方面的变化较小。这突出了在评估mTBI和其他损伤事件对军事卫生系统的影响时考虑既往利用率和成本的重要性。
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