Abstract
Objectives
To examine regional differences in rehabilitation outcomes among adult patients with
moderate-to-severe traumatic brain injury (TBI) who received care at an inpatient
rehabilitation facility (IRF).
Design
We conducted a secondary analysis of a large, multi-center dataset from the Uniform
Data System for Medical Rehabilitation.
Setting
More than 70% of all IRFs in the United States.
Participants
Adult TBI patients (N=175,358) aged 18 years or older who were admitted and discharged
from an IRF in the United States between 2004 and 2014. Qualifying etiology included
traumatic brain dysfunction Impairment Group codes 02.21 (traumatic, open injury)
and 02.22 (traumatic, closed injury).
Interventions
Not applicable.
Main Outcome Measures
Discharge functional status (total, cognitive, motor), length of stay, and discharge
to home.
Results
Patient and clinical characteristics varied significantly by geographic location,
as did median functional status, length of stay, and percentage of patients discharged
home. The region where IRF care was received, race and ethnicity, age, occurrence
of 1 or more falls during the IRF stay, case mix group, and insurance status were
associated with discharge functional status, length of stay, and discharge to home.
Conclusions
Our findings provide evidence of geographic differences in outcomes and potential
disparities in care of TBI patients who received IRF care. More research is needed
to identify TBI patients at risk for poor discharge outcomes to inform development
and testing of interventions to reduce disparities in outcomes for these patients.
Keywords
List of abbreviations:
CMS (Center for Medicare and Medicaid Services), ICD (International Classification of Diseases), IQR (interquartile range), IRF (inpatient rehabilitation facility), LOS (length of stay), TBI (traumatic brain injury), UDSMR (Uniform Data System for Medical Rehabilitation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 27, 2020
Footnotes
Supported by internal funds from the Emory University School of Medicine Department of Emergency Medicine.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
