Abstract
Objective
To investigate trends of hospital-based health care utilization after admission to
a level I trauma center after acute traumatic brain injury (TBI).
Design
Retrospective review.
Setting
Large urban trauma hospital and a hospital council data registry consisting of 88
member institutions (>150 hospitals) covering 15,000 square miles.
Participants
All patients (N=5291) admitted to a level I trauma center between January 1, 2006,
and June 30, 2014, who experienced an acute TBI based on International Classification of Diseases, Ninth Revision coding.
Interventions
Not applicable.
Main Outcome Measures
Included the incidence and type of select hospital-based services received. Analyses
were also categorized based on demographic and injury-related information.
Results
Of the 5291 patients with newly acquired TBI who were admitted, 512 died, leaving
4779 patients for inclusion in the final analysis. Additional health care utilization
from January 1, 2006, and June 30, 2014, was recorded for 3158 patients (66%), totaling
12,307 encounters, with a median of 3 encounters (interquartile range, 1–5) and a
maximum of 102 encounters. Most nonadmission urgent or procedural visits (96%) and
inpatient encounters (93%) occurred in the first year. Of all the additional encounters,
9769 visits were nonadmission urgent or procedural visits (79%) with a median charge
of $1955. The most common type of encounter was elective (46%), followed by medical
emergency (29%). Of the remaining 2538 inpatient encounters (21%), the mean length
of stay was 6 days with a median charge of $28,450. Medical emergency (39%) and elective
admissions (33%) again were the most common encounter type.
Conclusions
This analysis encompasses health care utilization across the range of TBI severity
and numerous hospital systems, allowing for a more comprehensive and objective identification
of reasons for readmission. This represents an initial step to developing a preventive
intervention to manage secondary complications postinjury.
Keywords
List of abbreviations:
DFWHCF (Dallas–Fort Worth Hospital Council Foundation), DRG (diagnosis-related group), ICD-9 (International Classification of Diseases, Ninth Revision), LOS (length of stay), LTAC (long-term acute care), SNF (skilled nursing facility), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 06, 2016
Footnotes
Supported by the Ginger Murchison Foundation Traumatic Brain Injury Research Fund and by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant no. 90DP0045-01-0). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
