Determinants of Utilization and Cost of VHA Care by OEF/OIF Veterans Screened for Mild Traumatic Brain Injury (original) (raw)
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Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury
Journal of Rehabilitation Research and Development, 2013
Over 12 mo following their initial evaluation, Veterans screening positive on a traumatic brain injury (TBI) clinical reminder had over 85 percent higher total costs than Veterans who screened negative. Understanding healthcare utilization and cost patterns following TBI screening is important for policymakers as they address the ongoing and future healthcare needs of returning Operation Iraqi Freedom/Operation Enduring Freedom Veterans.
Trauma, 2020
Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adj...
2013
BACKGROUND The Veterans Health Administration screens for traumatic brain injury (TBI) among all its patients who were deployed to Afghanistan or Iraq. This paper reports patient-level results of the screening program in 2008 and 2009 including rates of referrals and utilization. METHODS We based rates of positive screens on all screened patients from October 2007 through March 2009 as captured in VHA electronic records of screenings. We derived rates of TBI confirmed by comprehensive evaluations only from October 2008 through July 2009 as captured in VHA electronic evaluations records. We obtained patient characteristics from Department of Defense and VHA data. RESULTS Of 216,335 VHA patients screened from October 2007 through March 2009, we estimate that 14.6% had traumatic brain injury. For patients with a confirmed brain injury, the proportion using only VHA services was higher (86%) than for those with brain injury ruled out (77%). Patients with confirmed brain injury were more likely to have referrals (82% compared to 64%), but lack of referrals did not prevent the patients from getting VHA care. In the year after screening, 96% of evaluated patients with referrals received outpatient care, while 90% of those with no referral did so. CONCLUSIONS The VHA TBI screening process is inclusive, providing follow-up evaluation to almost 25% of screened servicemembers, 59% of whom are diagnosed with TBI. Clinicians refer virtually all those evaluated for further VHA care. Generalizability of the rate of traumatic brain injury is limited to those who seek Veterans Administration health care.
2008
: In a July 2006 report, the VA Office of Inspector General (OIG), Office of Healthcare Inspections (OHI) described the health status of and services provided for a group of service members and veterans who had received inpatient rehabilitative care in VA facilities for traumatic brain injury (TBI) sustained during or after tours of duty in Iraq or Afghanistan. At the request of the Chairman of the Senate Committee on Veterans' Affairs, the OIG conducted a follow-up assessment to determine the extent to which the Veterans Health Administration (VHA) maintains involvement with these same individuals to ensure that their health care needs are met. OHI inspectors extracted data on VA health care utilization from electronic medical records. Interviews with patients and/or family members were conducted by telephone or in person, and all participants were given explicit permission to decline participation. Interviewers inquired about changes since the initial interview in 2005. Specif...
Women's Health Issues, 2014
Background: Female service members' presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI). Methods: The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE). Findings: Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs. Conclusion: As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting. Published by Elsevier Inc. Female service members' presence in combat zones during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) is unprecedented both in terms of the number of women deployed and the nature of their involvement during deployment (Street, Vogt, & Dutra, 2009). Currently, women represent a greater proportion of U.S. military forces than ever before, comprising 10% to 20% of forces deployed in support of OEF/OIF, equaling nearly 300,000 deployed female troops from 2003 to 2013 (Burrelli, 2013; National Center for Veterans Analysis and Statistics, 2010). In future U.S. military operations, female Conflict of Interest: All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. All listed authors satisfy the three ICMJE requirements for authorship credit. To the best of our knowledge, no conflict of interest, financial or other, exists. We have included acknowledgements, conflicts of interest, and funding sources.
American Journal of Public Health, 2018
Objectives. To examine the role of Department of Defense policies in identifying theater-sustained traumatic brain injuries (TBIs). Methods. We conducted a retrospective study of 48 172 US military service members who sustained their first lifetime TBIs between 2001 and 2016 while deployed to Afghanistan or Iraq. We used multivariable negative binomial models to examine the changes in TBI incidence rates following the introduction of Department of Defense policies. Results. Two Army policies encouraging TBI reporting were associated with an increase of 251% and 97% in TBIs identified following their implementation, respectively. Among airmen, the introduction of TBI-specific screening questions to the Post-Deployment Health Assessment was associated with a 78% increase in reported TBIs. The 2010 Department of Defense Directive Type Memorandum 09-033 was associated with another increase of 80% in the likelihood of being identified with a TBI among soldiers, a 51% increase among sailo...
Military Medicine, 2011
The objective of this study was to compare the 1-year VA health care service use and costs between male and female Veterans returning from deployment in Afghanistan and Iraq. Using VA administrative data, measures of health care service use and costs were computed for male and female veterans in the year after last deployment. Service use and cost measures included inpatient care, outpatient care, prescription drugs, and fee basis care. Unadjusted differences by gender were evaluated using chi-square and t -tests, and differences adjusted for age, race/ethnicity, education, branch of service, rank, and service-connected status were evaluated using generalized linear models with log links. Study fi ndings indicated that although unadjusted total costs were higher for males than females, this difference did not remain after adjusting for covariates. However, adjusted inpatient costs were lower for women compared to those for men, and outpatient and pharmacy costs were higher.
Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury
Global Journal of Health Science, 2015
Traumatic Brain Injury (TBI) has gained attention in the past decade as a "signature injury" in the conflicts in Iraq and Afghanistan. TBI is a major burden for both the military and civilian population in the US and worldwide. It is a leading cause of death and disability in the US and a major health services resource burden.
Prevalence and Screening of Traumatic Brain Injury Among Veterans Seeking Mental Health Services
Journal of Head Trauma Rehabilitation, 2013
Objectives: To assess the prevalence of traumatic brain injury (TBI) among Veterans seeking mental health services using a 4-item tool, the Traumatic Brain Injury-4 (TBI-4), and to establish the classification accuracy of the TBI-4 using the Ohio State University TBI-Identification Method as the criterion standard. Study Design: Archival and observational data collected from individuals seeking care at a Mountain State VA Medical Center. Participants: The sample for the archival study was 1810. Three hundred sixteen Veterans completed observational study measures. Main Measures: For the archival study, TBI-4 and demographic data extracted from electronic medical records. For the observational study, the Ohio State University TBI-Identification Method and a demographic questionnaire were used. TBI-4 data were also obtained from electronic medical records. Results: The prevalence of probable TBI among those seeking VA MH treatment was 45%. Sensitivity and specificity of the TBI-4 were 0.74 and 0.56, respectively. Veterans with all levels of TBI severity sought care within this VA mental health setting. Conclusions: The prevalence of TBI in this VA mental health treatment population was higher than expected. Additional research is required to assess the clinical utility of screening for TBI among this population of Veterans.
"Objective: To estimate the number of undocumented incident traumatic brain injuries (TBIs) among active component US military personnel serving in Iraq and Afghanistan prior to policy changes implemented in late 2006 and 2010 that improved TBI documentation. Methods: Negative binomial regression was used to model monthly incident TBI counts between December 2010 and June 2012 (N = 19) and then estimate expected monthly counts of incident TBIs during 2 periods: January 2003-October 2006 and November 2006-November 2010. Monthly amputation counts from Department of Defense surveillance data were used as a proxy for changing injury rates. Monthly active component deployment estimates derived from the Congressional Research Service, Brookings Institution, and Defense Manpower Data Center were used to estimate the size of the at-risk population each month. The difference between expected monthly incident TBI counts and reported counts is presented as the estimated number of undocumented incident TBIs. Results: The full model estimates that 21 257 active component military personnel experienced undocumented incident TBIs while deployed in Iraq or Afghanistan between January 2003 and October 2006, more than 4 times the 5272 incident TBIs documented during that period. Conclusions: A sizeable majority of Iraq and Afghanistan combat veterans who experienced incident TBI while deployed prior to November 2006 are likely to have had their injuries undocumented, creating challenges for clinical care, disability evaluation, and future research."