Provider Differences in Costs, Utilization, and Quality of Primary Care for Traumatic Brain Injury in the Military

Objectives: Differences in costs, utilization, and quality of care provided by primary care physicians (PCPs) versus nurse practitioners (NPs) and physician assistants (PAs) for mild traumatic brain injury (mTBI) were examined to determine savings and address PCPs shortage. Methods: The Military Data Repository, which includes claims records for beneficiaries in the Military Health System, was used. Active-duty service members, retirees, and military dependents diagnosed with mTBI from 2011 to 2021 were included. Total cost, relative value units, and quality indicators of primary visits were dependent variables. The sample was stratified into patient-risk categories (high, low) and evaluation and management services (new and established patients). Results: Per military patient, PAs and NPs provided care at a lower cost than PCPs, with savings of $53.2 to $99.9 and $72.0 to $275.5, respectively. Per dependent patient, PAs provided care at a lower cost than PCPs, with savings of $64.3 to $91.1; NPs provided care at a lower cost than PCPs, with savings of $71.4 and $81.6. For quality for military patients, PAs ordered fewer brain and spine imaging (4.2%) and conducted fewer depression assessments (6%) than PCPs for patients with “new/high” risk. NPs conducted a higher proportion of neuropsychological testing (1.6%) for patients with “existing/high” risk compared with PCPs. For dependents, PAs conducted more health risk assessments and physical exams (2.5%) for patients with “existing/low” risk compared with PCPs. A total of 7.5% of patients with “new/low” risk treated by NPs compared to PCPs experienced fewer readmissions. Conclusions: NPs and PAs provide services for mTBI at lower costs than PCPs, with mixed results for quality.