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2023 HSR&D/QUERI National Conference Abstract

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1059 — Impact of Posttraumatic Amnesia duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs TBI Model Systems Study

Lead/Presenter: Clara Dismuke-Greer,  Resource Center - HERC
All Authors: Dismuke-Greer CE (Health Economics Resource Center, VA Palo Alto Health Care System), Almeida E (Research Department, Craig Hospital, Englewood, CO) Silva MA (Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Department of Psychiatry & Behavioral Neurosciences and Department of Internal Medicine Sleep & Pulmonary Division, Morsani College of Medicine, University of South Florida, Tampa, FL) Dams-O'Connor K (Department of Rehabilitation and Human Performance and Department of Neurology, Icahn School of Medicine, New York, NY) Rocek G (Research and Development Service, James A. Haley Veterans’ Hospital, Tampa, FL) Phillips LM (Research and Development Service, James A. Haley Veterans’ Hospital, Tampa, FL) Walker W (Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA) Nakase-Richardson R (Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Department of Internal Medicine Sleep & Pulmonary Division, Morsani College of Medicine, University of South Florida, and DHA Traumatic Brain Injury Center of Excellence, Tampa, FL)

Objectives:
To examine the association between Posttraumatic Amnesia (PTA) duration and first year Veterans Health Administration (VHA) hospitalization costs in military veterans and service members (V/SMs) treated for Traumatic Brain Injury (TBI) in VA Polytrauma rehabilitation Centers (PRCs). We also compared first year VA costs for veterans and military hospitalized in a PRC with the Veterans Equitable Resource Allocation (VERA) Patient Classification System dollar resource allocation for care for PRC hospitalized veterans.

Methods:
Design: Multivariable models of merged datasets from the Veterans Affairs TBI Model Systems (TBIMS) national database containing TBI clinical characterization including PTA with Veterans Health Administration (VHA) hospital cost data. Setting: Five VA Polytrauma Rehabilitation Centers. Participants: TBIMS participants (N = 910 veterans and 77 active-duty service members) who received inpatient rehabilitation at one of the five PRCs between 2010-2020 within 1 year of their TBI. Main Outcome Measures: total, acute care, rehabilitation, intensive care unit and surgery costs in VA hospitals.

Results:
Unadjusted mean total hospital costs in the first-year post TBI were approximately $201,214 higher for those with PTA duration ? 24 hours. In adjusted models, each additional day of PTA duration increased total ($1,452), rehabilitation ($1,324), ICU ($78) and surgery ($39) costs. Other significant covariates included age, acute care length of stay, Disability Rating Scale (DRS) on rehabilitation admission, penetrating violent cause of injury, and drug abuse. Penetrating violent mechanism of injury was associated with an $80,886 (9657:152114) increase in rehabilitation costs, relative to vehicular injuries Drug abuse as a comorbidity was associated with an $16,366 (95% CI 545:32186) increase in acute care costs.

Implications:
The results of this study may provide important information on more accurate hospitalization costs of a Polytrauma patient with TBI in their first year. Our data also suggest the need to stratify cost allocation by injury related factors. Veterans with more severe injury as measured by longer PTA duration require costlier care. Similarly, veterans with penetrating type TBI require costlier care than those with closed TBI mechanism of injury.

Impacts:
According to the FY2021 VERA Price allocation, for veterans in priority group 1-5, $77,964 was the FY 2021 allocation, while $69,916 was the allocation for those in priority group 6-8. These allocations are substantially lower than the unadjusted mean first year costs for the patients with TBI in this study, regardless of PTA.