OBJECTIVES: In France, one hundred and fifty thousand people suffer a traumatic brain injury (TBI) each year. Modeling and analyzing the care pathways of TBI patients will allow us to identify patients at risk of poor care, with the aim of optimizing care, improving their prognosis, and improving the efficiency of care pathways, which has never been done before. The objectives of the study were to identify and describe the care pathways (CPs) of patients with TBI, evaluate the costs of care, and assess the impact of social determinants on CPs and health care costs.

METHODS: TBI patients from Toulouse University Hospital were linked to national health insurance data (SNDS) to model CPs before and after TBI. CPs were identified using sequential multi-domain analysis (optimal matching and clustering). Health care costs were assessed from the perspective of the Health Insurance and the patient, in comparison with a control group. Mixed models were used to examine the impact of deprivation on care pathways and health care costs.

RESULTS: A cohort of 23,395 cases was matched with 70,185 controls. Among the cases, there were 2 distinct subpopulations in terms of age, gender, and deprivation. Cases also differed from controls in terms of deprivation (7% of cases received health insurance benefits vs. 4% of controls, p < 0.05) and psychiatric conditions (7% of cases vs. 3% of controls, p < 0.05). CPs were modeled by specialty for inpatient care and by provider type for outpatient care. Costs and out-of-pocket expenses for patients before and after TBI are currently being calculated.

CONCLUSIONS: Initial results show that deprivation is associated with higher CPs costs and determines their typology. The optimization of CPs must consider socio-economic characteristics. The goal is then to design more appropriate, effective, and equitable care programs.