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Healthcare Utilization Following Traumatic Brain Injury in a Large National Sample
Jennifer S Albrecht1, Emerson M Wickwire
1Departments of Epidemiology and Public Health (Dr Albrecht), Psychiatry (Dr Wickwire), and Medicine (Dr Wickwire), University of Maryland School of Medicine, Baltimore; and OptumLabs, Cambridge, Massachusetts (Dr Albrecht).
Objective:
To evaluate the impact of traumatic brain injury (TBI) on healthcare utilization (HCU) over a 1-year period in a large national sample of individuals diagnosed with TBI across multiple care settings.
Setting:
Commercial insurance enrollees.
Participants:
Individuals with and without TBI, 2008-2014.
Design:
Retrospective cohort.
Main Measures:
We compared the change in the 12-month sum of inpatient, outpatient, emergency department (ED), and prescription HCU from pre-TBI to post-TBI to the same change among a non-TBI control group. Most rehabilitation visits were not included. We stratified models by age ≥65 and included the month of TBI in subanalysis.
Results:
There were 207 354 individuals in the TBI cohort and 414 708 individuals in the non-TBI cohort. Excluding the month of TBI diagnosis, TBI resulted in a slight increase in outpatient visits (rate ratio [RtR] = 1.05; 95% confidence interval [CI], 1.04-1.06) but decrease in inpatient HCU (RtR = 0.86; 95% CI, 0.84-0.88). Including the month of TBI in the models resulted in increased inpatient (RtR = 1.55; 95% CI, 1.52-1.58) and ED HCU (RtR = 1.37; 95% CI, 1.34-1.40).
Conclusion:
In this population of individuals who maintained insurance coverage following TBI, results suggest that TBI may have a limited impact on nonrehabilitation HCU at the population level.
