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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)To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: January 06, 2018
Footnotes
Supported by the Administration for Community Living, National Institute on Disability, Independent Living, and Rehabilitation Research; Advanced Rehabilitation Research Training; and Traumatic Brain Injury Model Systems (grant nos. 90AR5014 and 90DP0047).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
