Clinical and Financial Impacts of Caring for Mild TBI Patients in the Rural Upper Midwest

BackgroundHealthcare disparities often cause rural BIG 1 TBI patients to be transferred to a higher level of care due to a fear of clinical decline.MethodsWe conducted a retrospective cohort study from 2020 to 2022 that compared patients with the principal diagnosis of BIG1 TBI who were transferred from rural critical access facilities in the upper Midwest to a tertiary care center vs those who were admitted directly to the same tertiary care center. The primary outcomes were cost and mortality. Statistical significance in mortality rates and length of stay was determined using Pearson's Chi Squared and Kruskal-Wallis tests, with significance thresholds set at α = 0.05.Results62 BIG1 patients were examined in the study and 18 were excluded. Of the 44 patients studied, there were no deaths in either group, and length of stay was not significant (P = .36). Transferred patients also underwent more head CT scans when compared to directly admitted patients (mean 2.5 vs 2.1, P = .003). For in-network costs, the average cost of transferred patients was $13,956 and the average cost for direct admissions was $9216 (P = .0003). For out-of-network costs, the average cost of transferred patients was $20,041 and the average cost for direct admission was $13,789 (P = .02).ConclusionCompared to patients who are directly admitted, transfer patients have an increased cost of care while having no difference in clinical outcomes. Technological advances in telemedicine and protocolized care may assist with decreasing the cost while increasing efficiency of care for these patients.