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Cited by 9Traumatic Brain Injury ResearchTrauma and Emergency Care StudiesTraumatic Brain Injury and Neurovascular Disturbances

Characterizing health care utilization following hospitalization for a traumatic brain injury: a retrospective cohort study

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Eliacin, Johanne, Yang, Ziyi, Kean, Jacob, Dixon, Brian E.·2021·Brain Injury
DOI 10.1080/02699052.2020.1861650PMC PMC12171970
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Abstract

Objective: The purpose of this study was to characterize health services utilization among individuals hospitalized with a traumatic brain injury (TBI) 1-year post-injury.Methods: Using a retrospective cohort design, adult patients (n = 32, 042) hospitalized with a traumatic brain injury between 2005 and 2014 were selected from a statewide traumatic brain injury registry. Data on health services utilization for 1-year post-injury were extracted from electronic medical and administrative records. Descriptive statistics and logistic regression were used to characterize the cohort and a subgroup of superutilizers of health services.Results: One year after traumatic brain injury, 56% of participants used emergency department services, 80% received inpatient services, and 93% utilized outpatient health services. Superutilizers had ≥3 emergency department visits, ≥3 inpatient admissions, or ≥26 outpatient visits 1-year post-injury. Twenty-six percent of participants were superutilizers of emergency department services, 30% of inpatient services, and 26% of outpatient services. Superutilizers contributed to 81% of emergency department visits, 70% of inpatient visits, and 60% of outpatient visits. Factors associated with being a superutilizer included sex, race, residence, and insurance type.Conclusions: Several patient characteristics and demographic factors influenced patients’ healthcare utilization post-TBI. Findings provide opportunities for developing targeted interventions to improve patients’ health and traumatic brain injury-related healthcare delivery.

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  1. [1]Centers for Disease Control and Prevention. Report to congress on traumatic brain injury in the United States: epidemiology and rehabilitation. National center for injury prevention and control, division of the unintentional injury prevention 2015. 26184889
  2. [2]Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, Guzman BR, Hemphill JD. Surveillance for traumatic brain injury-related deaths–United States, 1997–2007. MMWR Surveill Summ. 2011 May 6; 60(5): 1– 32. 21544045
  3. [3]Corrigan JD, Hammond FM. Traumatic brain injury as a chronic health condition. Arch Phys Med Rehabil. 2013 Jun; 94 (6): 1199– 201. doi: 10.1016/j.apmr.2013.01.023. 23402722 · DOI
  4. [4]Dismuke CE, Gebregziabher M, Egede LE. Racial/ethnic disparities in VA services utilization as a partial pathway to mortality differentials among veterans diagnosed with TBI. Glob J Health Sci. 2015 Jul 19; 8(2): 260– 72. PMC4803961 26383194
  5. [5]Masel BE, DeWitt DS. Traumatic brain injury: a disease process, not an event. J Neurotrauma. 2010 Aug; 27(8): 1529– 40. doi: 10.1089/neu.2010.1358. 20504161 · DOI
  6. [6]Zaloshnja E, Miller T, Langlois JA, Selassie AW. Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. J Head Trauma Rehabil. 2008 Nov- Dec; 23(6): 394– 400. doi: 10.1097/01.HTR.0000341435.52004.ac. 19033832 · DOI
  7. [7]Dillahunt-Aspillaga C, Nakase-Richardson R, Hart T, Powell-Cope G, Dreer LE, Eapen BC, Barnett SD, Mellick D, Haskin A, Silva MA. Predictors of employment outcomes in veterans with traumatic brain injury: A VA TRAUMATIC BRAIN INJURY MODEL SYSTEMS STUDY. J Head Trauma Rehabil. 2017 Jul/ Aug; 32 (4): 271– 82. doi: 10.1097/HTR.0000000000000275. 28060203 · DOI
  8. [9]Hu J, Ugiliweneza B, Meyer K, Lad SP, Boakye M. Trend and geographic analysis for traumatic brain injury mortality and cost based on MarketScan database. J Neurotrauma. 2013 Oct 15; 30 (20): 1755– 61. doi: 10.1089/neu.2013.2857. 23642155 · DOI
  9. [10]Shigaki CL, Johnstone B, Schopp LH. Financial and vocational outcomes 2 years after traumatic brain injury. Disabil Rehabil. 2009; 31 (6): 484– 89.doi: 10.1080/09638280802240449. 19034724 · DOI
  10. [11]Stocchetti N, Zanier ER. Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review. Crit Care (London, England). 2016 Jun 21; 20(1): 148. doi: 10.1186/s13054-016-1318-1. PMC4915181 27323708 · DOI
  11. [12]Marwitz JH, Cifu DX, Englander J, High WM Jr. A multi-center analysis of rehospitalizations five years after brain injury. J Head Trauma Rehabil. 2001 Aug; 16(4): 307– 17. doi: 10.1097/00001199-200108000-00002. 11461654 · DOI
  12. [13]Stroupe KT, Smith BM, Hogan TP, St Andre JR, Pape T, Steiner ML, Proescher E, Huo Z, Evans CT. Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. J Rehabil Res Dev. 2013; 50(8): 1047– 68.doi: 10.1682/JRRD.2012.06.0107. 24458891 · DOI
  13. [14]Greene NH, Kernic MA, Vavilala MS, Rivara FP. Variation in Adult Traumatic Brain Injury Outcomes in the United States. J Head Trauma Rehabil. 2018 Jan/ Feb; 33(1): E1– e8. doi: 10.1097/HTR.0000000000000306. PMC5647202 28422899 · DOI
  14. [15]Taylor BC, Hagel Campbell E, Nugent S, Bidelspach DE, Kehle-Forbes SM, Scholten J, Stroupe KT, Sayer NA. Three year trends in veterans health administration utilization and costs after traumatic brain injury screening among veterans with mild traumatic brain injury. J Neurotrauma. 2017 Sep; 34(17): 2567– 74. doi: 10.1089/neu.2016.4910. 28482747 · DOI
  15. [16]Thompson HJ, Weir S, Rivara FP, Wang J, Sullivan SD, Salkever D, MacKenzie EJ. Utilization and costs of health care after geriatric traumatic brain injury. J Neurotrauma. 2012 Jul 1; 29(10): 1864– 71. doi: 10.1089/neu.2011.2284. 22435729 PMC3390979 · DOI
  16. [17]Biondich PG, Grannis SJ. The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience. J Public Health Manag Pract. 2004 Nov;(Suppl): S81– 6. doi: 10.1097/00124784-200411001-00013. 15643364 · DOI
  17. [18]Overhage J. The Indiana health information exchange. In: Dixon B, editor. Health information exchange: navigating and managing a network of health information systems. 1 ed. Waltham, MA: Academic Press; 2016.
  18. [20]Dixon BE The Indiana TBI/SCI Registry: a resource for research and surveillance. Indiana Spinal Cord and Brain Injury Research Conference; Indianapolis. IN2016
  19. [21]Rahurkar S, McFarlane TD, Wang J, Hoover S, Hammond F, Kean J, Dixon BE. Leveraging health information exchange to construct a registry for traumatic brain injury, spinal cord injury and stroke in Indiana. AMIA Annu Symp Proc. 2017; 2017: 1440– 49. 29854213 PMC5977570
  20. [22]HOCHBERG Y A sharper Bonferroni procedure for multiple tests of significance. Biometrika. 1988; 75(4): 800– 02.doi: 10.1093/biomet/75.4.800. · DOI · Paper page
  21. [23]Rafiq M, Keel G, Mazzocato P, Guttmann C, Lindgren P, Savage C. Extreme consumers of health care: patterns of care utilization in patients with multiple chronic conditions admitted to a novel integrated clinic. J Multidiscip Healthc. 2019; 12: 1075– 83. 31920324 PMC6935286
  22. [25]Rinehart DJ, Oronce C, Durfee MJ, Ranby KW, Batal HA, Hanratty R, Vogel J, Johnson TL. Identifying subgroups of adult superutilizers in an urban safety-net system using latent class analysis: implications for clinical practice. Med Care. 2018; 56: 1. 27632768 PMC5406260
  23. [26]Šimundić A-M. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009; 19(4): 203– 11. 27683318 PMC4975285
  24. [28]Slewa-Younan S, Baguley IJ, Heriseanu R, Cameron ID, Pitsiavas V, Mudaliar Y, Nayyar V. Do men and women differ in their course following traumatic brain injury? A preliminary prospective investigation of early outcome. Brain Inj. 2008 Feb; 22(2): 183– 91. doi: 10.1080/02699050801888808. 18240047 · DOI
  25. [29]Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006 Sep- Oct; 21(5): 375– 78. doi: 10.1097/00001199-200609000-00001. 16983222 · DOI
  26. [31]Chang VC, Ruseckaite R, Collie A, Colantonio A. Examining the epidemiology of work-related traumatic brain injury through a sex/gender lens: analysis of workers’ compensation claims in Victoria, Australia. Occup Environ Med. 2014 Oct; 71(10): 695– 703. doi: 10.1136/oemed-2014-102097. 25052083 · DOI
  27. [32]Raukar NP, Zonfrillo MR, Kane K, Davenport M, Espinoza TR, Weiland J, Franco V, Vaca FE. Gender- and sex-specific sports-related injury research in emergency medicine: a consensus on future research direction and focused application. Acad Emerg Med. 2014 Dec; 21(12): 1370– 79. doi: 10.1111/acem.12535. 25420669 · DOI
  28. [33]Bazarian JJ, Blyth B, Mookerjee S, He H, McDermott MP. Sex differences in outcome after mild traumatic brain injury. J Neurotrauma. 2010 Mar; 27(3): 527– 39. doi: 10.1089/neu.2009.1068. 19938945 PMC2867588 · DOI
  29. [34]Farace E, Alves WM. Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury. Neurosurg Focus. 2000; 8(1): e6.doi: 10.3171/foc.2000.8.1.152. 16924776 · DOI
  30. [35]Herrera-Melero MC, Egea-Guerrero JJ, Vilches-Arenas A, Rincón-Ferrari MD, Flores-Cordero JM, León-Carrión J, Murillo-Cabezas F. Acute predictors for mortality after severe TBI in Spain: gender differences and clinical data. Brain Inj. 2015; 29(12): 1439– 44.doi: 10.3109/02699052.2015.1071428. 26305856 · DOI
  31. [36]Kraus JF, Peek-Asa C, McArthur D. The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus. 2000 Jan 15; 8(1): e5. doi: 10.3171/foc.2000.8.1.156. 16906701 · DOI
  32. [37]Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, Rusnak M. Effects of gender on outcomes after traumatic brain injury. J Trauma. 2011 Dec; 71(6): 1620– 26. 21808209
  33. [38]Morrison WE, Arbelaez JJ, Fackler JC, De Maio A, Paidas CN. Gender and age effects on outcome after pediatric traumatic brain injury. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2004 Mar; 5(2): 145– 51. doi: 10.1097/01.PCC.0000112373.71645.2A. 14987344 · DOI
  34. [39]Corrigan JD, Lineberry LA, Komaroff E, Langlois JA, Selassie AW, Wood KD. Employment after traumatic brain injury: differences between men and women. Arch Phys Med Rehabil. 2007 Nov; 88 (11): 1400– 09. doi: 10.1016/j.apmr.2007.08.006. 17964879 · DOI
  35. [40]Stergiou-Kita M, Mansfield E, Sokoloff S, Colantonio A. Gender influences on return to work after mild traumatic brain injury. Arch Phys Med Rehabil. 2016 Feb; 97(2 Suppl): S40– 5. doi: 10.1016/j.apmr.2015.04.008. 25921979 · DOI
  36. [42]Wright DW, Espinoza TR, Merck LH, Ratcliff JJ, Backster A, Stein DG. Gender differences in neurological emergencies part II: a consensus summary and research agenda on traumatic brain injury. Acad Emergency Med Off J Soc Acad Emergency Med. 2014 Dec; 21(12): 1414– 20. PMC4311997 25420582
  37. [43]Salisbury DB, Driver SJ, Reynolds M, Bennett M, Petrey LB, Warren AM. Hospital-based health care after traumatic brain injury. Arch Phys Med Rehabil. 2017 Mar; 98(3): 425– 33. doi: 10.1016/j.apmr.2016.09.117. 27720843 · DOI
  38. [44]Asakawa K, Feeny D, Senthilselvan A, Johnson JA, Rolfson D. Do the determinants of health differ between people living in the community and in institutions? Soc Sci Med. 1982 2009 Aug; 69 (3): 345– 53. doi: 10.1016/j.socscimed.2009.05.007. 19527920 · DOI
  39. [45]Delcher C, Yang C, Ranka S, Tyndall JA, Vogel B, Shenkman E. Variation in outpatient emergency department utilization in Texas Medicaid: a state-level framework for finding “superutilizers”. Int J Emerg Med. 2017 Dec 4; 10(1): 31. doi: 10.1186/s12245-017-0157-4. 29204728 PMC5714939 · DOI
  40. [46]Vickery KD, Bodurtha P, Winkelman TNA, Hougham C, Owen R, Legler MS, Erickson E, Davis MM. Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion. Health Aff(Project Hope). 2018 Jan; 37(1): 62– 69. doi: 10.1377/hlthaff.2017.0991. 29309230 · DOI
  41. [47]Ng SH, Rahman N, Ang IYH, Sridharan S, Ramachandran S, Wang DD, Tan CS, Toh SA, Tan XQ. Characterization of high healthcare utilizer groups using administrative data from an electronic medical record database. BMC Health Serv Res. 2019 Jul 5; 19(1): 452. 31277649 PMC6612067
  42. [48]Hudon C, Chouinard MC, Dubois MF, Roberge P, Loignon C, Tchouaket É, Lambert M, Hudon É, Diadiou F, Bouliane D. Case management in primary care for frequent users of health care services: a mixed methods study. Ann Fam Med. 2018 May; 16 (3): 232– 39. doi: 10.1370/afm.2233. 29760027 PMC5951252 · DOI
  43. [49]Moe J, Kirkland SW, Rawe E, Ospina MB, Vandermeer B, Campbell S, Rowe BH. Effectiveness of interventions to decrease emergency department visits by adult frequent users: a systematic review. Acad Emerg Med. 2017 Jan; 24(1): 40– 52. doi: 10.1111/acem.13060. 27473387 · DOI
  44. [50]Ryan GK, Kamuhiirwa M, Mugisha J, Baillie D, Hall C, Newman C, Nkurunungi E, Rathod SD, Devries KM, De Silva MJ, Mpango R. Peer support for frequent users of inpatient mental health care in Uganda: protocol of a quasi-experimental study. BMC Psychiatry. 2019 Nov 29; 19(1): 374. doi: 10.1186/s12888-019-2360-8. 31783827 PMC6883561 · DOI
  45. [51]Johnson TL, Rinehart DJ, Durfee J, Brewer D, Batal H, Blum J, Oronce CI, Melinkovich P, Gabow P. For many patients who use large amounts of health care services, the need is intense yet temporary. Health Aff (Millwood). 2015 Aug; 34(8): 1312– 19. doi: 10.1377/hlthaff.2014.1186. 26240244 · DOI
  46. [52]Mitchell MS, León CLK, Byrne TH, Lin WC, Bharel M. Cost of health care utilization among homeless frequent emergency department users. Psychol Serv. 2017 May; 14(2): 193– 202. doi: 10.1037/ser0000113. 28481604 · DOI
  47. [53]Burns TR. Contributing factors of frequent use of the emergency department: A synthesis. Int Emerg Nurs. 2017 Nov; 35: 51– 55. doi: 10.1016/j.ienj.2017.06.001. 28676296 · DOI
  48. [54]Nguyen OK, Tang N, Hillman JM, Gonzales R. What’s cost got to do with it? Association between hospital costs and frequency of admissions among “high users” of hospital care. J Hosp Med. 2013 Dec; 8(12): 665– 71. doi: 10.1002/jhm.2096. 24173680 · DOI
  49. [55]Lin MP, Blanchfield BB, Kakoza RM, Vaidya V, Price C, Goldner JS, Higgins M, Lessenich E, Laskowski K, Schuur JD. ED-based care coordination reduces costs for frequent ED users. Am J Manag Care. 2017 Dec; 23(12): 762– 66. 29261242
  50. [57]Institute of Medicine Committee on the Future Health Care Workforce for Older A. Retooling for an Aging America: building the Health Care Workforce. Washington (DC): National Academies Press (US) Copyright 2008 by the National Academy of Sciences. All rights reserved; 2008. 25009893
  51. [58]Kalkan A, Bodegard J, Sundstrom J, Svennblad B, Östgren CJ, Nilsson PN, Johansson G, Ekman M. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice. Prim Care Diabetes. 2017 Apr; 11 (2): 184– 92. doi: 10.1016/j.pcd.2016.11.002. 27894781 · DOI
  52. [59]McFarlane TD, Love J, Hanley S, Dixon BE, Hammond FM. Increased Risk of Stroke Among Young Adults With Serious Traumatic Brain Injury. J Head Trauma Rehabil. 2020 May/ Jun; 35(3): E310– E319. doi: 10.1097/HTR.0000000000000539. 31834059 · DOI · Paper page
  53. [60]Gao S, Kumar RG, Wisniewski SR, Fabio A. Disparities in health care utilization of adults with traumatic brain injuries are related to insurance, race, and ethnicity: a systematic review. J Head Trauma Rehabil. 2018 May/ Jun; 33(3): E40– E50. doi: 10.1097/HTR.0000000000000338. 28926481 PMC5857393 · DOI
  54. [61]Meagher AD, Beadles CA, Doorey J, Charles AG. Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury. J Neurosurg. 2015 Mar; 122 (3): 595– 601. doi: 10.3171/2014.10.JNS14187. 25415069 · DOI
  55. [62]Missios S, Bekelis K. The association of insurance status and race with the procedural volume of traumatic brain injury patients. Injury. 2016 Jan; 47(1): 154– 59. doi: 10.1016/j.injury.2015.06.037. 26187434 · DOI

Cited by

Sorted by citations

Authors
Eliacin, J., Yang, Z., Kean, J., & Dixon, B. E.
Affiliations
  • Regenstrief Institute (US)
  • Indiana University – Purdue University Indianapolis (US)
  • University of Utah (US)
Corresponding author
Eliacin, Johanne
ORCID
Venue
Brain Injury
Publisher
Informa UK Limited
Published
2020-12-24
Volume
35
Issue
1
Pages
119-129
ISSN
  • 0269-9052 (ISSN-L)
  • 1362-301X
DOI
10.1080/02699052.2020.1861650
PMC
PMC12171970
OpenAlex
W3116104045
Cited by
9
References
3
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2022: 2
FWCI
0.36
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain Injury (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion, public-domain)
  • IUScholarWorks (Indiana University) (submittedVersion, public-domain)
  • Purdue University Indianapolis (Indiana University) (submittedVersion, public-domain)
Funders
  • Indiana Spinal Cord & Brain Injury Research Fund, Indiana State Department of Health (0000000000000000000029083)
  • VA Rehabilitation Research and Development (Career Development Award (IK2RX000879))
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Keywords
traumatic brain injury, health care utilization, emergency department visits, hospitalization, outpatient visits, post-hospital care, health disparities, insurance type, sex differences, racial differences, health care delivery
MeSH terms
Brain Injuries, Traumatic, Adult, Emergency Service, Hospital, Hospitalization, Humans, Patient Acceptance of Health Care, Retrospective Studies, Cohort Studies

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