兰德-Understanding-Treatment-of-Mild-Traumatic-Brain-Injury-in-the-Military-Health-System_147页_899kb

Summary of "Understanding Treatment of Mild Traumatic Brain Injury in the Military Health System"

Core Content

This report provides an analysis of the treatment patterns and characteristics of nondeployed active-duty service members diagnosed with mild traumatic brain injury (mTBI) in 2012 through the Military Health System (MHS). It addresses the lack of large-scale studies on mTBI care within the MHS and offers insights to help improve care delivery and outcomes.

Main Objectives

• To characterize the population of nondeployed service members diagnosed with mTBI.
• To identify the co-occurring symptoms and conditions.
• To examine the locations, types, and duration of care received.
• To provide recommendations for the MHS based on findings.

Key Findings

1. Prevalence of mTBI

• Approximately 8-20% of service members may have experienced a TBI, with 84% being mild.
• Between 2008 and 2013, the number of nondeployed active-duty service members receiving treatment for mTBI increased from about 18,700 to nearly 22,000, with a steady number through 2012.
• In 2012, 10% of the mTBI cohort had a history of prior TBI treatment.

2. Demographics and Service Characteristics

• Nondeployed service members with a new mTBI in 2012 were relatively young and junior enlisted.
• Half of the cohort were junior enlisted personnel.
• The average years of service was six, with two-thirds having a history of deployment.
• Deployed service members had an average of 16 cumulative months of deployment before their 2012 mTBI diagnosis.
• Army personnel were more likely to have been deployed (79%) and had longer deployment periods than those from other branches.

3. Co-Occurring Conditions

• 11-16% of service members received treatment for behavioral health conditions in the six months following their mTBI diagnosis.
• Common co-occurring conditions included:
  • Behavioral Health: adjustment disorders, PTSD, anxiety disorders, depression, alcohol abuse/dependence.
  • Symptoms/Conditions: headache, chronic pain, sleep disorders, memory loss, dizziness, hearing issues, cognitive problems, etc.
• A higher proportion of service members received treatment for these conditions after their mTBI diagnosis compared to before.

4. Location of Care

• 60% of the 2012 mTBI cohort were diagnosed in the direct care system (military treatment facilities).
  • 40% were diagnosed in primary care clinics.
  • 35% were diagnosed in emergency departments.
• 40% of the cohort was diagnosed through the purchased care system (community care, TRICARE).
  • 80% of those received their diagnosis in an emergency department.
• 40% of service members had their next health care encounter in a primary care setting.

5. Duration and Patterns of Care

• Service members received care for an average of 3.5 months in the six months following their mTBI diagnosis.
• The majority of care occurred within the first month.
• Persistent care (beyond three months) was observed in a subset of service members.
• The pattern of care varied by service branch and deployment history.

6. Types of Care and Treatments

• Diagnostic Assessments:
  • 60% of service members received a neurological evaluation.
  • 54% received a behavioral health evaluation.
• Therapies and Treatments:
  • Behavioral health therapies were the most common.
  • Physical therapies and medications were also used.
• Medications:
  • Commonly prescribed medications included:
    • Analgesics for pain.
    • Antidepressants and anxiolytics for mental health conditions.
    • Sleep aids for sleep disorders.
  • Medication use increased significantly in the six months following the mTBI diagnosis.

7. Persistent Care

• Service members receiving persistent care had more severe or complex conditions.
• They were more likely to have:
  • A history of deployment.
  • Co-occurring behavioral health conditions.
  • Longer duration of care.
• Persistent care was associated with a higher likelihood of receiving behavioral health treatments and medications.

Key Recommendations

• Standardize mTBI case definitions to ensure consistency in data collection and analysis.
• Improve screening and diagnosis protocols to better identify and manage co-occurring conditions.
• Enhance coordination of care between the MHS and community providers, especially for those receiving purchased care.
• Develop targeted interventions for service members with persistent symptoms, including behavioral health support and long-term monitoring.
• Expand data collection to include clinical notes and improve the accuracy of diagnoses.

Limitations

• The study focused only on nondeployed active-duty service members.
• Clinical notes were not included in the analysis, limiting the depth of understanding of individual patient experiences.
• The data did not account for care received outside the MHS, as it only included care paid for by the MHS.

Conclusion

This report offers a comprehensive overview of mTBI treatment within the MHS, highlighting the demographics, co-occurring conditions, care settings, and treatment patterns of nondeployed service members. It provides a foundation for improving care delivery and outcomes for mTBI patients, with recommendations for policy and practice improvements. The findings are also relevant to the U.S. Department of Veterans Affairs and other health systems dealing with mTBI in civilians and military personnel.