Advertisement

Comorbidity and Insurance as Predictors of Disability After Traumatic Brain Injury

      Abstract

      Objective

      To examine the unique contribution of self-reported medical comorbidity and insurance type on disability after traumatic brain injury (TBI).

      Design

      Inception cohort design at 1-year follow up.

      Setting

      A university affiliated rehabilitation hospital.

      Participants

      Adults with mild-complicated to severe TBI (N=70).

      Intervention

      Not applicable.

      Main Outcome Measures

      Self-reported medical comorbidities were measured using the Modified Cumulative Illness Rating Scale, while insurance type was classified as commercial or government-funded; disability was measured using the Disability Rating Scale.

      Results

      Two models were run using multiple linear regression, and the best-fitting model was selected on the basis of Bayesian information criterion. The full model, which included self-reported medical comorbidity and insurance type, was significantly better fitting than the reduced model. Participants with a longer duration of posttraumatic amnesia, more self-reported medical comorbidities, and government insurance were more likely to have higher levels of disability. Meanwhile, individual organ systems were not predictive of disability.

      Conclusions

      The cumulative effect of self-reported medical comorbidities and type of insurance coverage predict disability above and beyond well-known prognostic variables. Early assessment of medical complications and improving services provided by government-funded insurance may enhance quality of life and reduce long-term health care costs.

      Keywords

      List of abbreviations:

      BIC (Bayesian information criterion), DRS (Disability Rating Scale), EENT (eye/ear/nose/throat), HMO (health maintenance organization), MCIRS (Modified Cumulative Illness Rating Scale), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Available from: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf. Accessed March 20, 2013.

        • Webb C.R.
        • Wrigley M.
        • Yoels W.
        • Fine P.R.
        Explaining quality of life for persons with traumatic brain injuries 2 years after injury.
        Arch Phys Med Rehabil. 1995; 76: 1113-1119
        • Orman J.A.L.
        • Kraus J.F.
        • Zaloshnja E.
        • Miller T.
        Epidemiology.
        in: Silver J.M. McAllister T.W. Yudofsky S.C. Textbook of traumatic brain injury. 2nd ed. American Psychiatric Pub, Washington (DC)2011: 3-22
        • Finkelstein E.A.
        • Corso P.C.
        • Miller T.R.
        • Fiebelkorn I.A.
        • Zaloshnja E.
        • Lawrence B.A.
        Incidence and economic burden of injuries in the United States.
        Oxford Univ Pr, New York2006
        • Holcomb E.M.
        • Millis S.R.
        • Hanks R.A.
        Comorbid disease in persons with traumatic brain injury: descriptive findings utilizing the modified cumulative illness rating scale.
        Arch Phys Med Rehabil. 2012; 93: 1338-1342
        • Lucas J.A.
        • Addeo R.
        Traumatic brain injury and postconcussion syndrome.
        in: Snyder P.J. Nussbaum P.D. Robins D.L. Clinical neuropsychology: a pocket handbook for assessment. 2nd ed. American Psychological Association, Washington (DC)2009: 351-380
        • Fujii D.
        • Ahmed I.
        • Hishinuma E.
        A neuropsychological comparison of psychotic disorder following traumatic brain injury, traumatic brain injury without psychotic disorder, and schizophrenia.
        J Neuropsychiatry Clin Neurosci. 2004; 16: 306-314
        • Jorge R.E.
        • Acion L.
        • Starkstein S.E.
        • Magnotta V.
        Hippocampal volume and mood disorders after traumatic brain injury.
        Biol Psychiatry. 2007; 62: 332-338
        • Rao V.
        • Munro C.
        • Rosenberg P.
        • et al.
        Neuroanatomical correlates of depression in post traumatic brain injury: preliminary results of a pilot study.
        J Neuropsychiatry Clin Neurosci. 2010; 22: 231-235
        • Zafonte R.D.
        • Cullen N.
        • Lexell J.
        Serotonin agents in the treatment of acquired brain injury.
        J Head Trauma Rehabil. 2002; 17: 322-334
        • Semah F.
        • Picot M.C.
        • Adam C.
        • et al.
        Is the underlying cause of epilepsy a major prognostic factor for recurrence?.
        Neurology. 1998; 51: 1256-1262
        • Colantonio A.
        • Ratcliff G.
        • Chase S.
        • Vernich L.
        Aging with traumatic brain injury: long-term health conditions.
        Int J Rehabil Res. 2004; 27: 209-214
        • Marion D.W.
        • Penrod L.E.
        • Kelsey S.F.
        • et al.
        Treatment of traumatic brain injury with moderate hypothermia.
        N Engl J Med. 1997; 336: 540-546
        • Clifton G.L.
        • Allen S.
        • Berry J.
        • Koch S.M.
        Systemic hypothermia in treatment of brain injury.
        J Neurotrauma. 1992; 9: S487
        • Stiver S.I.
        Complications of decompressive craniectomy for traumatic brain injury.
        Neurosurg Focus. 2009; 26: 7
        • Benumof J.
        • Hagberg C.A.
        Benumof’s airway management: principles and practice.
        Mosby Inc, Philadelphia2007
        • Pilitsis J.G.
        • Rengachary S.S.
        Complications of head injury.
        Neurol Res. 2001; 23: 227-236
        • Richard I.
        • Hamon M.A.
        • Ferrapie A.L.
        • Rome J.
        • Brunel P.
        • Mathe J.F.
        [Tracheostomy in brain injured patients: which patients? Why? When? How?].
        Ann Fr Anesth Reanim. 2005; 24 ([French]): 659-662
        • Stauffer J.L.
        • Olson D.E.
        • Petty T.L.
        Complications of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill patients.
        Am J Med. 1981; 70: 65-76
        • Rimmer J.H.
        Exercise and physical activity in persons aging with a physical disability.
        Phys Med Rehabil Clin N Am. 2005; 16: 41-56
        • Bassuk S.S.
        • Manson J.E.
        Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease.
        J Appl Physiol. 2005; 99: 1193-1204
        • Berlin J.A.
        • Colditz G.A.
        A meta-analysis of physical activity in the prevention of coronary heart disease.
        Am J Epidemiol. 1990; 132: 612-628
        • Laaksonen D.E.
        • Lakka H.M.
        • Salonen J.T.
        • Niskanen L.K.
        • Rauramaa R.
        • Lakka T.A.
        Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome.
        Diabetes Care. 2002; 25: 1612-1618
        • Liou T.H.
        • Pi-Sunyer F.X.
        • Laferrere B.
        Physical disability and obesity.
        Nutr Rev. 2005; 63: 321-331
        • Rogers J.M.
        • Read C.A.
        Psychiatric comorbidity following traumatic brain injury.
        Brain Inj. 2007; 21: 1321-1333
        • Bombardier C.H.
        • Fann J.R.
        • Temkin N.R.
        • Esselman P.C.
        • Barber J.
        • Dikmen S.S.
        Rates of major depressive disorder and clinical outcomes following traumatic brain injury.
        JAMA. 2010; 303: 1938-1945
      2. Rapoport MJ. Depression following traumatic brain injury. CNS Drugs 2012;26:111-121.

        • Giaquinto S.
        • Palma E.
        • Maiolo I.
        • et al.
        Importance and evaluation of comorbidity in rehabilitation.
        Disabil Rehabil. 2001; 23: 296-299
        • Lew H.L.
        • Lee E.
        • Date E.S.
        • Zeiner H.
        Influence of medical comorbidities and complications on FIM (TM) change and length of stay during inpatient rehabilitation.
        Am J Phys Med Rehabil. 2002; 81: 830-837
        • Chan L.
        • Ciol M.A.
        Medicare’s payment system: its effect on discharges to skilled nursing facilities from rehabilitation hospitals.
        Arch Phys Med Rehabil. 2000; 81: 715-719
        • Retchin S.M.
        • Brown R.S.
        • Yeh S.-C.
        • Chu D.
        • Moreno L.
        Outcome of stroke patients in Medicare fee for service and managed care.
        JAMA. 1997; 278: 119-124
        • Chan L.
        • Doctor J.
        • Temkin N.
        Discharge disposition from acute care after traumatic brain injury: the effects of insurance type.
        Arch Phys Med Rehabil. 2001; 82: 1151-1154
        • Nirula R.
        • Nirula G.
        • Gentilello L.
        Inequity of rehabilitation services after traumatic injury.
        J Trauma. 2008; 66: 255-259
        • Heffernan D.S.
        • Vera R.M.
        • Monaghan S.F.
        • et al.
        Impact of socioethnic factors on outcomes following traumatic brain injury.
        J Trauma. 2011; 70: 527-534
        • Shafi S.
        • de la Plata C.M.
        • Diaz-Arrastia R.
        • et al.
        Racial disparities in long-term functional outcome after traumatic brain injury.
        J Trauma Acute Care Surg. 2007; 63: 1263-1270
        • Corrigan J.D.
        • Cuthbert J.P.
        • Whiteneck G.G.
        • et al.
        Representativeness of the Traumatic Brain Injury Model Systems Database.
        J Head Trauma Rehabil. 2011; 26: 1-9
        • Kashluba S.
        • Hanks R.A.
        • Casey J.E.
        • Millis S.R.
        Neuropsychologic and functional outcome after complicated mild traumatic brain injury.
        Arch Phys Med Rehabil. 2008; 89: 904-911
        • Salvi F.
        • Miller M.D.
        • Grilli A.
        • et al.
        A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients.
        J Am Geriatr Soc. 2008; 56: 1926-1931
        • Rappaport M.
        • Hall K.M.
        • Hopkins K.
        • Belleza T.
        • Cope D.N.
        Disability rating scale for severe head trauma: coma to community.
        Arch Phys Med Rehabil. 1982; 63: 118-123
        • Cowen T.D.
        • Meythaler J.M.
        • DeVivo M.J.
        • Ivie III, C.S.
        • Lebow J.
        • Novack T.A.
        Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.
        Arch Phys Med Rehabil. 1995; 76: 797-803
        • Hammond F.M.
        • Grattan K.D.
        • Sasser H.
        • et al.
        Five years after traumatic brain injury: a study of individual outcomes and predictors of change in function.
        NeuroRehabilitation. 2004; 19: 24-35
        • Oddy M.
        • Coughlan T.
        • Tyerman A.
        • Jenkins D.
        Social adjustment after closed head injury: a further follow-up seven years after injury.
        J Neurol Neurosurg Psychiatry. 1985; 48: 564-568
        • Ponsford J.
        • Draper K.
        • Schonberger M.
        Disability 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status.
        J Int Neuropsychol Soc. 2008; 14: 233-242
        • Hukkelhoven C.W.
        • Steyerberg E.W.
        • Rampen A.J.
        • et al.
        Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients.
        J Neurosurg. 2003; 99: 666-673
        • Shavelle R.
        • Strauss D.
        • Day S.
        • Ojdana K.
        Life expectancy.
        in: Zasler N.D. Katz D.I. Zafonte R.D. Brain injury medicine: principles and practice. Demos Medical, New York2007: 247-261
        • Stevens J.
        Applied multivariate statistics for the social sciences.
        Erlbaum, Hillsdale1986
        • Tabachnick B.G.
        • Fidel L.S.
        Using multivariate statistics.
        2nd ed. Harper & Row, New York1989
        • Raftery A.E.
        Approximate Bayes factors and accounting for model uncertainty in generalised linear models.
        Biometrika. 1996; 83: 251-266
        • Ruff R.M.
        • Lorraine C.
        • Mueller J.
        Miserable minority: emotional risk factors that influence the outcome of mild traumatic brain injury.
        Brain Inj. 1996; 10: 551-566
        • Lange R.T.
        • Iverson G.L.
        • Rose A.
        Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury.
        J Head Trauma Rehabil. 2011; 26: 127-137
      3. LongTermCare.gov. Available from: http://longtermcare.gov/medicare-medicaid-more/medicare/. Accessed July 31, 2013.

      4. Choices for older or disabled persons who may need help caring for themselves. Michigan: Michigan.gov. 2012. Available from: http://www.michigan.gov/mdch/0, 4612,7-132-2943_4857_5045-16263–,00.html. Accessed July 31, 2013.

      5. Bihari M. HMOs vs. PPOs – what are the differences between HMOs and PPOs? 2010. Available from: http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm. Accessed July 31, 2013.

        • Adelmann P.K.
        Mental and substance abuse disorders among Medicaid recipients: prevalence estimates from two national surveys.
        Admin Policy Ment Health. 2003; 31: 111-129