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Titre : | Health Services Utilization, Health Care Costs, and Diagnoses by Mild Traumatic Brain Injury Exposure: A Chronic Effects of Neurotrauma Consortium Study (2020) |
Auteurs : | Clara E. Dismuke-Greer ; Shawn Hirsch ; Kathleen F. Carlson ; Terri K. Pogoda ; Risa Nakase-Richardson ; Subhash C. Bhatnagar ; Blessen C. Eapen ; Maya Troyanskaya ; Shannon R. Miles ; Tracy Nolen ; William C. Walker |
Type de document : | Article : Périodique |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 101, n° 10, 2020) |
Article en page(s) : | p. 1720-1730 |
Note générale : | https://doi.org/10.1016/j.apmr.2020.06.008 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Anciens combattants ; Coûts et analyse des coûts ; Lésions encéphaliques ; Réadaptation ; Traumatisme |
Résumé : |
Objective
To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs nonblast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study. Design Prospective cohort study. Setting Four Veterans Affairs Medical Centers. Participants OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017. Interventions Not applicable. Lifetime mTBI history was assessed via semistructured interviews. Main Outcome Measures VHA diagnoses, health services utilization, and costs. Results Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864). Conclusions Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999320304214 |