全球智库信息集成服务系统

Understanding the Characteristics of Service Members with mTBI and Their Patterns of Treatment Can Inform the Delivery of High-Quality Care

• Service members who received treatment for a new mTBI diagnosis in 2012 tended to be young and junior enlisted.
• Most service members appeared to recover quickly following their mTBI diagnosis, but a minority had complex and persistent care needs.
• Most service members with a new mTBI diagnosis were diagnosed in an emergency department and had their next health care visit in a primary care setting.
• Many service members with a new mTBI diagnosis also received treatment for co-occurring behavioral health conditions, pain, and sleep disorders.
• Service members with a new mTBI diagnosis received a variety of assessments and treatments, such as CT scans, physical therapy, and pain medication, in the six months following the mTBI diagnosis, but there were differences by whether the service member had experienced a prior TBI.

Variations in Diagnostic Coding and Other Data Limitations Pose Challenges to Identifying Service Members with mTBI and Profiling Their Care

• Health care providers face confusing diagnostic coding guidelines and use inconsistent coding practices when diagnosing and treating TBI.

Variations in Diagnostic Coding and Other Data Limitations Pose Challenges to Identifying Service Members with mTBI and Profiling Their Care

• Available data track the characteristics of service members and their care, but there is a critical need for data on clinical outcomes, patient satisfaction, and other factors that would provide a more complete picture of an episode of mTBI care and more specific guidance for improving the quality of care for service members with mTBI.

Traumatic brain injury (TBI) is considered a signature injury of modern warfare, though TBIs can also result from training accidents, falls, sports, and motor vehicle accidents. Among service members diagnosed with a TBI, the majority of cases are mild TBIs (mTBIs), also known as concussions. Many of these service members receive care through the Military Health System, but the amount, type, and quality of care they receive has been largely unknown. A RAND study, the first to examine the mTBI care of a census of patients in the Military Health System, assessed the number and characteristics (including deployment history and history of TBI) of nondeployed, active-duty service members who received an mTBI diagnosis in 2012, the locations of their diagnoses and next health care visits, the types of care they received in the six months following their mTBI diagnosis, co-occurring conditions, and the duration of their treatment. While the majority of service members with mTBI recover quickly, the study further examined a subset of service members with mTBI who received care for longer than three months following their diagnosis. Diagnosing and treating mTBI can be especially challenging because of variations in symptoms and other factors. The research revealed inconsistencies in the diagnostic coding, as well as areas for improvement in coordinating care across providers and care settings. The results and recommendations provide a foundation to guide future clinical studies to improve the quality of care and subsequent outcomes for service members diagnosed with mTBI.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  How Many Service Members Receive Treatment for mTBI?

• Chapter Four

  What Are the Characteristics of Nondeployed Active-Duty Service Members Who Receive Treatment for an mTBI Through the MHS?

• Chapter Five

  Where Do Nondeployed Active-Duty Service Members with mTBI Receive Care?

• Chapter Six

  What Are the Duration and Patterns of Health Care in the Six Months After an mTBI Diagnosis?

• Chapter Seven

  What Types of Care Do Nondeployed Active-Duty Service Members with mTBI Receive in the Six Months After Their mTBI Diagnosis?

• Chapter Eight

  Who Receives Persistent Care Following mTBI Diagnosis?

• Chapter Nine

  Findings and Recommendations

• Appendix A

  Using ICD-9 Codes to Identify mTBI

• Appendix B

  Comparison and Variation Using the Project and Other ICD-9 Definitions

• Appendix C

  ICD-9 to ICD-10 Considerations

• Appendix D

  Variable Definitions

• Appendix E

  Additional Analyses