title: Does Co-Occurring Traumatic Brain Injury Affect VHA Outpatient Health Service Utilization and Associated Costs Among Veterans With Posttraumatic Stress Disorder? An Examination Based on VHA Administrative Data.
abstract: To examine whether a traumatic brain injury (TBI) diagnosis was associated with increased outpatient service utilization and associated costs among Iraq and Afghanistan (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]/Operation New Dawn [OND]) War veterans with posttraumatic stress disorder (PTSD) who used Veterans Health Affairs (VHA) care in a 1-year period.
  
  
  
  N/A.
  
  
  
  OEF/OIF/OND veterans with a diagnosis of PTSD and/or TBI who utilized VHA services during fiscal year 2012 (N = 164 644).
  
  
  
  Observational study using VHA administrative data.
  
  
  
  Outpatient VHA utilization (total and by category of care) and associated costs (total and by VA Health Economic Resource Center cost category).
  
  
  
  Veterans in the comorbid PTSD/TBI group had significantly more total outpatient appointment than veterans with PTSD but no TBI. This pattern held for all categories of care except orthopedics. The comorbid TBI/PTSD group ($5769) incurred greater median outpatient healthcare costs than the PTSD ($3168) or TBI-alone ($2815) group.
  
  
  
  Co-occurring TBI increases the already high level of healthcare utilization by veterans with PTSD, suggesting that OEF/OIF/OND veterans with comorbid PTSD/TBI have complex and wide-ranging healthcare needs.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VHA Health Care System, Minneapolis, Minnesota (Drs Kehle-Forbes, Taylor, and Sayer and Ms Campbell); Departments of Medicine (Drs Kehle-Forbes, Taylor, and Sayer) and Psychiatry (Dr Sayer), University of Minnesota, Minneapolis; and Physical Medicine & Rehabilitation Service, Washington DC VA Medical Center (Dr Scholten).
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Kehle-Forbes
authors.forename: Emily Hagel
authors.initials: EH
authors.lastname: Campbell
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Joel
authors.initials: J
authors.lastname: Scholten
authors.forename: Nina
authors.initials: N
authors.lastname: Sayer
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult