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Long-Term Medical Care Utilization and Costs Among Traumatic Brain Injury Survivors

Categories: Outcomes

The Question

What are the long-term medical care and utilization costs for people with traumatic brain injury (TBI)?

Past Studies

Past Studies have shown that brain injury is a major financial challenge for individuals, their families and society. People with TBI and other persons with disabilities have a higher rate of health care utilization and costs associated with these services. Individuals with TBI have medical issues that are uncommon to other populations, such as cognitive impairment and motor dysfunction Increased costs following inpatient rehabilitation may be caused by more frequent use of outpatient medical services once individuals with TBI return to the community. There is little research regarding the association between adherence to recommended treatment plans and long-term health issues. Yet, because people with TBI have cognitive impairments in memory, attention and executive functioning, they may have difficulty adhering to medication regimens, keeping appointments and following other protocols of their treatment plan.

Researchers recommend a user-friendly network of specialized primary care providers and barrier-free outpatient clinics to encourage faster, more effective treatment while reducing service costs.

This Study

This Study focuses on the assessment of long-term utilization and costs of medical care associated with TBI as well as the unique needs of this population. The study examined the healthcare billing patterns of 63 individuals with TBI who were enrolled in the Rehabilitation Institute of Michigan Primary Care Program. This follow-up program provided accessible healthcare at a clinic within the rehabilitation center, as well as transportation by van, for patients needing this service. The study looked at billing patterns over a 19 month period to identify service utilization patterns and explore service utilization predictors. The authors expected a positive relationship between the severity of the individual’s motor deficits, utilization and cost of medical intervention. It was assumed that these factors would be predictive of increased costs for medication, primary care, medical equipment and supplies. They also expected that the severity of the injury would be related to the intensity of medical follow-up, increased utilization of the emergency department and use of medications.The 63 individuals who participated in the study included 11 women and 52 men injured through violence (46%), auto collisions (29%), falls (12%) and other causes (13%). All participants were at least one- year post-injury. They ranged in age from 17 years to 63 years with an average age of 33 years. Fifty-two were African American (32%), four were white (6%), one was Hispanic (2%), and six (10%) were multi-racial. Average Glasgow Coma Scale (GCS) was 8 for most participants in the 24 hours immediately after brain injury. The average number of months that the participants sought medical services was 13, with a maximum of 19 months and minimum of two months. This data was available for 53 of the 63 participants.Total billings, charges and payments for the 63 participants were calculated for the entire 19 month period and were divided into ten billing types: outpatient, residential, home health care, state case management, emergency department, inpatient, medications, primary care, medical equipment /supplies and transportation.The researchers found that motor disability was a predictor of service utilization and total charges after inpatient discharge. Commonly, home healthcare, medical equipment, and outpatient services were used. There was little relationship between motor disability and prescription drug charges. The severity of the brain injury was not a significant factor in service utilization.

Who May Be Affected By These Findings

People with brain injury and their families, caregivers, health professionals, researchers, community providers.


Limitations to this study included the small sample size and use of data from only one hospital. Only data from Medicaid was included, and billings did not always reflect the true cost to providers or the amount paid by individuals and society through Medicaid. Authors suggest that billing charges should be considered as an overestimate of true costs, and Medicaid payments considered as an underestimate of true costs. They further suggest that future research should look at the influence of cognitive status on adherence to treatment and how it affects utilization of services and costs.

Bottom Line

Changes in motor scores provided unique information in predicting utilization and costs after accounting for severity of injury and demographic characteristics. Motor disability and improvement were predictive of future utilization and cost for individuals with TBI.

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Find This Study

Vangel, S.J., Rapport, L.J., Hanks, R.A., Black, K.L.(2005). Long-term medical care utilization and costs among traumatic brain injury survivors. American Journal of Physical Medicine and Rehabilitation, 84; 153-160.