Describing the patient journey through healthcare pathways following mild traumatic brain injury in New Zealand using novel Graph analysis

To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand. Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient’s injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics’ effect on healthcare outcomes were evaluated. In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12–185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims. Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended.本研究旨在明确新西兰轻度创伤性脑损伤（mild traumatic brain injury, mTBI）患者的治疗服务提供者序列、医疗服务路径特征及转归结局。本研究利用全国医疗数据（涵盖患者伤情与接受的医疗服务信息），分析了mTBI相关总医疗成本及核心路径特征。针对存在多次就诊记录的索赔案件，通过图谱分析生成治疗服务提供者类型序列，并对比了两类医疗转归结局：医疗成本及路径退出时长。同时评估了核心路径特征对医疗转归结局的影响。两年内共有55494例被受理的mTBI索赔案件，相关医疗成本在四年间累计达93647261美元，由ACC（Accident Compensation Corporation）支付。在存在多次就诊记录的索赔案件（占比36%）中，医疗服务路径的中位时长为49天（四分位距interquartile range, IQR：12~185天）。本次研究共识别出89类治疗服务提供者，由此生成3396种不同的服务提供者序列，其中25%仅由全科医生（General Practitioners, GP）构成，13%为从急诊科（Emergency Department, ED）到全科医生的序列（ED-GP），5%为从全科医生到脑震荡门诊（Concussion Service, CS）的序列（GP-CS）。就诊初期即获得准确mTBI诊断的医疗路径，其退出时长更短、医疗成本更低。收入维持补贴占总医疗成本的52%，但仅覆盖20%的索赔案件。通过投入资源开展服务提供者培训以提升其mTBI诊断准确率，可优化mTBI患者的医疗服务路径，进而实现长期医疗成本节约。研究建议出台相关干预措施以降低收入维持补贴相关成本。