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Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation

Published:January 06, 2018DOI:https://doi.org/10.1016/j.apmr.2017.11.016

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      • Simultaneous co-occurrence (ie, clustering) of some demographic and clinical variables may affect the acute rehabilitation outcomes of patients with traumatic brain injury, rendering ethic/racial minority and elderly groups particularly vulnerable to shorter stays despite small gains in functional variables.

      Abstract

      Objective

      To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.

      Design

      Cluster analysis of historical patient data obtained from inpatient visits.

      Setting

      Inpatient rehabilitation unit in a large urban university hospital.

      Participants

      Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury.

      Interventions

      Not applicable.

      Main Outcome Measures

      We examined the membership of patients with traumatic brain injury in various “vulnerable group” clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge).

      Results

      The cluster analysis revealed 4 major clusters (ie, clusters A–D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.

      Conclusions

      Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various “at-risk” groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training, and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation after traumatic brain injury.

      Keywords

      List of abbreviations:

      ESL (English as a second language), TBI (traumatic brain injury)
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