Utilization and Cost of VA Outpatient Clinics for Service Members and Veterans Treated in VA Polytrauma Rehabilitation Centers for Traumatic Brain Injury: A VA TBI Model Systems Study.

OBJECTIVE

To examine the postinjury utilization and cost of Veterans Affairs (VA) outpatient care in a cohort of service members and veterans (SMVs) treated in VA Polytrauma Rehabilitation Centers (PRCs) for traumatic brain injury (TBI).

DESIGN

Analysis of merged datasets from the VA TBI Model Systems (VA-TBIMS) national database and Veterans Health Administration outpatient utilization and cost data.

SETTING

Five VA PRCs.

PARTICIPANTS

VA-TBIMS participants (N = 1,030) who received inpatient rehabilitation at any of the 5 PRCs between 2010 and 2020.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Utilization and costs of VA outpatient clinics.

RESULTS

Polytrauma/TBI clinics had the highest SMVs (87.9%), with 54.4% also using telephone. Laboratories (78.6%) had the second highest, and primary care (77.1%) had the third. The 1030 SMVs treated in PRCs had a median annual VA outpatient facility cost of $15,027. The costliest clinic type was mental health ($6834), followed by TBI/Polytrauma ($4747) + phone ($1229), and physical therapy ($4441). SMVs had a median of 4.1 years since injury. Time to care increased costs by $42 per day for inpatient rehabilitation and $29,426 5 years after injury for outpatient care. Each additional point on the Disability Rating Scale increased total costs by $593, whereas sexual dysfunction increased total costs by $8214.

CONCLUSIONS

VA PRCs are a gateway for SMVs to use VA Polytrauma/TBI clinic outpatient services, highlighting the VA Polytrauma System of Care as a framework for continuing critical clinical health services after inpatient rehabilitation. Indeed, time to access inpatient rehabilitation as well as outpatient care was associated with increasingly higher costs. Disability Rating Scale was a cost driver for SMVs treated in PRCs, consistent with previous studies of VA and Department of Defense costs. Sexual dysfunction emerged as an important condition impacting VA outpatient costs, confirming evidence of its link to TBI and its importance to Veterans.