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BACKGROUND/RATIONALE:
Traumatic Brain Injury (TBI) often causes life-long deficits in cognitive and social function that can be more disabling than the physical impairments. The majority of veterans and soldiers with TBI fall within two categories: 1) those who sustained TBI in civilian environment via accidents such as motor vehicle crashes and falls, and 2) combat-related TBI resulting from blasts/explosions, and projectiles. Veterans and soldiers with combat-related TBI may be more complicated to treat than their civilian counterparts due to the war-associated acute stress, post traumatic stress disorder (PTSD), and polytrauma.
OBJECTIVE(S):
Th objectives are:
1. To determine differences, if any, in cost patterns for rehabilitation among OEF/OIF returnees with combat-related TBI versus those with non-combat related TBI, for a period up to 12 months after initial discharge.
2. To compare the utility of Life Care Planning and FIM scores in predicting total rehabilitation costs for the same time period.
3. To examine how PTSD impacts future outcomes and costs associated with combat-related TBI.
METHODS:
This 6 month study will use a convenient sample of all veterans with a primary or secondary diagnosis of TBI who were admitted, treated and discharged from the Palo Alto and Tampa VA from 2004 to 2006. The approximately 200 OEF/OIF returnees discharged from the four Centers are eligible to be included in the study.
Inclusion/exclusion criteria: We will exclude from our study those OIF/OEF returnees who are institutionalized or candidates for nursing home placement. Such inclusion will almost certainly skew the underlying cost distributions.
Methods: It involves retrospective data analysis. It utilizes quantitative analysis for costs and utilization and analysis of outcome variables pertinent to physical and mental health of veterans with TBI. The design for this proposed project is a cohort analysis of TBI patients treated at the two PRCs. We will observe this cohort from the date of initial entry into the center up to the proposed end to data collection one year after initial entry.
Data: We have abstracted cost and utilization data (inpatient and outpatient) for over 300 veterans treated at the Tampa VA who are not veterans of OIF/OEF. We used primary and secondary ICD codes as listed below to identify individuals. We have cost and utilization data for over 70 combat returnees from OEF/OIF treated at the Polytrauma Center at Tampa. We will compare and contrast the two groups to determine differences in treatment and costs adjusting for PTSD as a confounding variable.
FINDINGS/RESULTS:
The following are the codes for TBI:
800.0-801.9 Fracture of the vault or base of the skull
803.0-804.9 Other and unqualified and multiple fractures of the skull
850.0-854.1 Intracranial injury, including concussion, contusion, laceration, and hemorrhage.
873.0 Scalp, without mention of complication
873.1 Scalp, complicated
873.3 Nose, complicated
873.4 Face, without mention of complication
873.5 Face, complicated
873.6 Internal structures of mouth, without mention of complication
873.7 Internal structures of mouth, complicated
873.8 Other and unspecified open wound of head without mention of complication
Head NOS
873.9 Other and unspecified open wound of head, complicated
IMPACT:
This study addresses areas of relevance to the Rapid Response Project RFA including (1) studying the impact of quality and/or outcomes via implementation of evidence-based clinical recommendations or practices and (2) analyzing associated rehabilitation costs.
The social and economic consequences of TBI are staggering. To explore alternative rehabilitation delivery mechanisms to veterans with TBI (such as TeleRehabilitation) and to design outreach programs, it is essential that underlying cost structures be understood and methodologies such as Life Care Planning be used for discharge purposes be evaluated on their ability to predict rehabilitation outcomes and associated costs. The Co-Investigator of this study, Kris Siddharthan PhD is the recipient of a VA HSR & D research grant (DHI-05-264) entitled ‘Treatment and Costs of Combat Related Blast Injuries in the VA’. That project pertains to acute and follow-up care for polytrauma in OIF/OEF veterans. The proposed study will constitute a logical and broader extension of research on transition and associated costs of one of the fallouts of polytrauma (namely TBI) care from VA facility to veterans’ homes for all veterans. Based on our findings we will propose studies (to be submitted to VA HSR & D or RR & D) to evaluate the efficacy of other instruments that better capture rehab patterns and associated costs among veterans with TBI. This preliminary study provides for gap identification in determining predictive tools and survey instruments for discharge purposes.
The findings will be shared with the PT/BRI QUERI plan for future studies.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Health Services and Systems, Military and Environmental Exposures
DRE:
Rehabilitation, Resource Use and Cost
Keywords:
Cost, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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