Healthcare utilization and costs associated with persistent post-concussive symptoms

ABSTRACT

Objective

To describe the healthcare utilization and costs associated with the interdisciplinary treatment of pediatric persistent post-concussive symptoms (PPCS).

Methods

A retrospective chart review was conducted with 461 youth referred by community physicians to an interdisciplinary pediatric PPCS outpatient clinic in Ontario, Canada. Healthcare utilization parameters included accessibility, continuity, comprehensiveness, and service productivity. Direct healthcare costs included those incurred by physicians and other interdisciplinary services. Indirect costs per client included travel to the clinic and caregiver productivity loss. Data analyses were completed using descriptive statistics.

Results

The median age of clients was 15 years (range = 3 to 18). The median wait time for an initial PPCS clinic physician consultation was 71 days, and less than 2 months for other interdisciplinary services. Eighty-two percent of clients were referred to at least one other service after an initial physician consultation. Occupational therapy received the highest proportion of referrals (79%). Total median direct costs per client were approximately $915, with a final accumulated cost of $532 623 for all clients. Caregiver productivity loss was approximately $387 per family.

Conclusions

Our findings suggest that interdisciplinary PPCS care represents an accessible, comprehensive and cost-saving healthcare model from the client and societal perspectives.

KEYWORDS:

• Healthcare economics
• concussion
• pediatric
• healthcare utilization
• interdisciplinary care

Acknowledgments

The authors would like to thank all of the children, youth and their families who have been seen through the Pediatric Persistent Concussion Clinic, this research would not be possible without you. We would also like to thank the Pediactric Persistent Concussion Clinic team at Holland Bloorview Kids Rehabilitation Hospital including Cyndy Bryson, Dr. Peter Rumney, Dr. Alysha Ladha, Dr. Ryan Hung, Dr. Janine Hay, Dr. Lily Riggs, Naomi Smith, Debra Moroz, Kim Moody, Erin Kohlmetz, Charlotte Coy and Tess Bardikoff. Lastly, we would like to thank the Novel Lab for their support throughout this project.

Disclosure statement

The author(s) report no conflicts of interest.

Contributors’ statement

Dr. Agnihotri and Dr. Scratch conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, drafted the initial manuscript, and critically reviewed and revised the manuscript. Lucy Xie and Kylie Mallory designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. Dr. Penner, Andrea Hickling, Nicholas Joachimides, and Elaine Widgett assisted with conceptualizing and designing the study, as well as critically reviewing the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.