Identification of hidden health utilization services and costs in adults awaiting tertiary care following mild traumatic brain injury in Toronto, Ontario, Canada

Cindy Hunt; Katrina Zanetti; Brian Kirkham; Alicja Michalak; Cheryl Masanic; Chantal Vaidyanath; Shree Bhalerao; Michael D Cusimano; Andrew Baker; Donna Ouchterlony

doi:10.2217/cnc-2016-0009

Identification of hidden health utilization services and costs in adults awaiting tertiary care following mild traumatic brain injury in Toronto, Ontario, Canada

Concussion. 2016 Aug 8;1(4):CNC21. doi: 10.2217/cnc-2016-0009. eCollection 2016 Dec.

Authors

Cindy Hunt^{1

2

1

2}, Katrina Zanetti^{1

1}, Brian Kirkham^{1

1}, Alicja Michalak^{1

1}, Cheryl Masanic^{1

3

1

3}, Chantal Vaidyanath^{1

3

1

3}, Shree Bhalerao^{1

4

1

4}, Michael D Cusimano^{4

5

4

5}, Andrew Baker^{6

7

6

7}, Donna Ouchterlony^{1

8

1

8}

Affiliations

¹ Head Injury Clinic, St. Michael's Hospital, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Brain & Spinal Cord Program & MSK Program, Toronto Rehabilitation Institute, Toronto, ON, Canada.
⁴ St. Michael's Hospital, Toronto, ON, Canada.
⁵ University of Toronto, Toronto, ON, Canada.
⁶ Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada.
⁷ Department of Anesthesia & Surgery, University of Toronto, Toronto, ON, Canada.
⁸ Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

Aim: The cognitive, emotional, behavioral and physical impairments experienced by adults after mild traumatic brain injury (mTBI) can produce substantial disability, with 15-20% requiring referral to tertiary care (TC) for persistent symptoms.

Methods: A convenience sample of 201 adult patients referred to TC as a result of mTBI was studied. Self-reported data were collected at first TC visit, on average 10 months postinjury. Patients reported the type and intensity of healthcare provider visit(s) undertaken while awaiting TC.

Results: On average males reported 37 and females 30 healthcare provider visits, resulting in over $500,000 Canadian dollars spent on potentially excess mTBI care over 1 year.

Discussion: Based on conservative estimate of 15% of mTBI patients receiving TC, this finding identifies a possible excess in care of $110 million for Ontario. Accurate diagnosis of mTBI and early coordination of follow-up care for those needing TC could increase cost-effectiveness.

Keywords: concussion; economic burden of disease; healthcare utilization; mild traumatic brain injury; traumatic brain injury.