130731-vapha mtbi presentation-2 - wild apricot … · 130731-vapha mtbi presentation-2.pptx...

6/4/14

1

Assessing Resource Demand for Treatment of Mild Traumatic Brain Injury in Navy

Medicine Ambulatory Clinics

Health on the Homefront:

Moira E. Crosby, MPH; Jessica L. Newton, MPH, PMP; Paul D. Rockswold, MD, MPH, FAAFP, CAPT, MC, USN (UMO/DMO)

1


Assessing Resource Demand for Treatment of Mild Traumatic Brain Injury in Navy Medicine

Ambulatory Clinics

Disclaimer

The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy,

Department of Defense, the U.S Government, or the Commonwealth of Virginia.

2



Ambulatory Clinics

Navy and Marine Corps Public Health Center •  Established in 1964 for Occupational Health •  Mission: “As the Navy and Marine Corps’ center for public health services, we provide leadership

and expertise to ensure mission readiness through disease prevention and health promotion in support of the National Military Strategy.”

•  Vision: Protection through Prevention

3



Ambulatory Clinics

Health Analysis Department •  Provide clinical performance measurement to change clinical processes

and improve patient outcomes and reduce costs. •  Customers include: Bureau of Navy Medicine and Surgery (BUMED),

Navy Medicine Regional Commands, Military Treatment Facilities (MTF), clinicians, residents, administrators and business staff

•  Provide input to guide Navy policy, lectures on epidemiology, health care measurement, scientific articles, and focused studies to examine feasibility of implementation and evaluation of specific interventions

4

6/4/14

2



Ambulatory Clinics

Objectives •  Provide a general overview of Traumatic Brain Injury (TBI), more

specifically, mild Traumatic Brain Injury (mTBI). •  Describe trends and distribution of mTBI encounters for Navy Medicine •  Recognize the importance of proper resource allocation for treatment and

program planning

5



Ambulatory Clinics

Background •  TBI has emerged as a signature condition among members of the U.S.

Armed Forces •  As of 2009, approximately 1.5 million Americans survive a TBI.

  Most reported TBIs (77%) are mild TBI (mTBI). •  mTBI is unlike moderate to severe TBI because:

  Physical injuries may not be apparent   Course of treatment is not clearly defined

6



Ambulatory Clinics

Background-Classification of mTBI

7



Ambulatory Clinics

Background-Definition of Mild Traumatic Brain Injury •  American Congress of Rehabilitation Definition of mTBI

  Must have at least 1 of the following: –  Any period of amnesia, LOC <30 minutes and GCS 13-15 –  Any post-traumatic amnesia <24 hours long –  Any alteration in mental status at time of accident

8

6/4/14

3



Ambulatory Clinics

Background-Clinical Practice Guidelines •  VA/Department of Defense Clinical Practice Guidelines Definition   At least 1 of the following must occur:

–  Any LOC –  Any Post-traumatic amnesia of immediately before/after injury –  Any AOC at time of injury –  Neurological deficits –  Intracranial lesion

9



Ambulatory Clinics

Background-mTBI Symptoms •  mTBI symptoms can be behavioral, cognitive, and/or physical alterations.

Examples include, but are not limited to:   Irritability, Impulsivity, Aggression   Attention difficulties, Memory and Judgment problems   Headache, Nausea, Vomiting, and Blurred Vision

10



Ambulatory Clinics

Background •  It is important to ensure the numerous military medicine resources

available are well allocated to treat the various symptoms.   Assessment performed at request of BUMED M9 TBI Program subject matter

experts –  Results assist M9 in determining if each MTF has the correct category of care

rating and capabilities to meet each care rating

11



Ambulatory Clinics

Methods-Coding Guidance •  Department of Defense Coding Guidance for Traumatic Brain Injury

  Coding initial encounter for TBI: –  8XX series code as primary code following by appropriate TBI V code •  May be associated with skull fracture (800-801/803-804) or without (850-854)

  Subsequent encounters for TBI care –  Use symptom codes for patient’s present complaint as primary code followed by: •  Personal history of TBI code (V15.52_X) •  Late effect code (905.0 or 907.0) •  Appropriate deployment status code

12

6/4/14

4



Ambulatory Clinics

13



Ambulatory Clinics

Methods-Parameters •  Project is based on proper coding

  Other military definitions are based on more comprehensive groups •  mTBI ICD-9 Codes as defined by DoD Coding Guidance:

  Personal History of TBI, GWOT related, Mild (V15.5_2, V15.59_2, V15.52_2)   Personal History of TBI, non-GWOT related, Mild (V15.5_7, V15.59_7, V15.52_7)   Person History of TBI, unknown if GWOT related, Mild (V15.5_C, V15.59_C,

V15.52_C)   Concussion (850.x)

14



Ambulatory Clinics

Methods-Parameters Continued •  All mTBI encounters at an ambulatory Navy MTF clinic during fiscal years

(FY) 2006-2013 (quarter 2) were included   mTBI encounter: any encounter in which 1 or more of the mTBI ICD-9 codes

were recorded within diagnosis 1-10 during any visit to an ambulatory clinic at an Navy MTF –  If a person has a mTBI encounter at multiple Navy MTFs, the person is counted as

an unique mTBI case at each facility –  An mTBI patient may have one or more episodes throughout the assessment time

period

15



Ambulatory Clinics

Methods-Data Collection •  Data collected via MHS Management and Analysis Reporting Tool (M2)

  Comprehensive Ambulatory/Professional Encounter Record (CAPER) detail table –  Includes only direct care; in-theater and shipboard data are not included

•  Encounters, clinic type where the encounter was coded, how the encounter was coded, and patient enrollment location were examined to determine overall burden

•  Encounter trends, clinic type prevalence, and frequency of proper diagnostic code used were reported

16

6/4/14

5



Ambulatory Clinics

Results-Overview •  Since FY06, coded mTBI encounters have increased •  From FY06 to Quarter 2 of FY13, there were 77,447 mTBI encounters

within Navy Treatment Facilities •  Of all mTBI encounters, approximately 77% were from active duty

patients   As of FY13Q2, Sailors and Marines were 26% and 60% of the unique active

duty mTBI cases, respectively •  5 Navy MTFs had 76% of coded active duty mTBI cases as of FY13Q2

17



Ambulatory Clinics

Active Duty mTBI Encounters within Navy Military Treatment Facilities, by Sponsor Service, FY06-FY13Q2

18



Ambulatory Clinics

Active Duty mTBI Cases within Navy Military Treatment Facilities, by Sponsor Service, FY13Q2

19



Ambulatory Clinics

Active Duty Navy and Marine Encounters within Navy Military Treatment Facilities, by Enrollment Status, FY13Q2

20

6/4/14

6



Ambulatory Clinics

New mTBI Episodes within Navy Military Treatment Facilities, Active Duty Navy and Marines, FY08-FY13Q2

21



Ambulatory Clinics

Active Duty Navy and Marine mTBI Encounters within Navy Military Treatment Facilities, by Documented ICD-9 Code, FY13Q2

22



Ambulatory Clinics

Active Duty Navy and Marine mTBI Encounters within Navy Military Treatment Facilities, by Documented ICD-9 Code, FY13Q2

23



Ambulatory Clinics

Conclusions •  Results of the assessment have become a biannual report delivered to

BUMED •  The assessment allowed BUMED TBI subject matter experts to identify

specific MTFs that have high mTBI encounter rates and may not yet have a TBI program at that institution   Allocation of resources and additional training for wounded warrior care

•  MTFs with TBI program were also looked at to ensure proper resources still available to meet each facility’s TBI care rating

24

6/4/14

7



Ambulatory Clinics

Conclusions-Future Directions •  Future directions:

  Analyze mTBI treatment resources at baseline to present day. –  Were resources allocated properly then? –  Are they properly allocated now?

  Data analysis of all TBI programs. –  Are the programs effective in treating and rehabilitating a TBI? –  How long-lasting are the effects of the program?

25



Ambulatory Clinics

Conclusions •  You should now:

  Have a general understanding of TBI, more specifically, mTBI   Be able to describe trends and distribution of mTBI encounters for Navy

Medicine   Have an deeper understanding of the importance of proper resource allocation

for treatment and program planning

26



Ambulatory Clinics

References •  Military Health System Coding Guidance: Professional Services and Specialty Coding Guidelines, Version 1.0, Unified

Biostatistical Utility, 2005. Appendix G: Special Guidance on Traumatic Brain Injury Coding, 2009. •  Marshall KR, Holland SL, Meyer KS, et al. Mild traumatic brain injury screening, diagnosis, and treatment. Military

Medicine 2012; 177(8): 67-75. •  Cameron KL, Marshall SW, Sturdivant RX, et al. Trends in the incidence of physician-diagnosed mild traumatic brain

injury among active duty U.S. military personnel between 1997-2007. Journal of Neurotrauma 2012; 29(7): 1313-1321. •  Department of Veterans Affairs and Department of Defense. (2008) Management of Concussion/ mild Traumatic Brain

Injury. Retrieved from http://www.healthquality.va.gov/management_of_concussion_mtbi.asp . Accessed on March 8, 2011.

•  Centers for Disease Control and Prevention. (2010, March 18). Heads Up: Facts for Physicians About Mild Traumatic Brain Injury (MTBI). Retrieved from http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html. Accessed on March 9, 2011.

•  Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group, American Congress of Rehabilitation. Definition of mild traumatic brain injruy. Journal of Head Trauma Rehabilitation 1993;8(3): 86-87.

•  VA Department of Defense Clinical Practice Guidelines. Management of Concussion/mild Traumatic Brain Injury, April 2009.

27



Ambulatory Clinics

Questions??

28

6/4/14

8



Ambulatory Clinics

Contact Health Analysis Department Email: [email protected] Website: www.nmcphc.med.navy.mil/Data_Statistics/Health_Analysis/ha_overview

29

130731-vapha mtbi presentation-2 - wild apricot … · 130731-vapha mtbi presentation-2.pptx...

Documents