Advertisement

Regional Variations in Rehabilitation Outcomes of Adult Patients With Traumatic Brain Injury: A Uniform Data System for Medical Rehabilitation Investigation

Published:August 27, 2020DOI:https://doi.org/10.1016/j.apmr.2020.07.011

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      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

        • de Koning M.E.
        • Spikman J.M.
        • Coers A.
        • Schönherr M.C.
        • van der Naalt J.
        Pathways of care the first year after moderate and severe traumatic brain injury—discharge destinations and outpatient follow-up.
        Brain Inj. 2015; 29: 423-429
        • Corrigan J.D.
        • Hammond F.M.
        Traumatic brain injury as a chronic health condition.
        Arch Phys Med Rehabil. 2013; 94: 1199-1201
        • Seel R.T.
        • Kreutzer J.S.
        • Rosenthal M.
        • Hammond F.M.
        • Corrigan J.D.
        • Black K.
        Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation.
        Arch Phys Med Rehabil. 2003; 84: 177-184
        • Walker W.C.
        • Pickett T.C.
        Motor impairment after severe traumatic brain injury: a longitudinal multicenter study.
        J Rehabil Res Dev. 2007; 44: 975-982
        • Seel R.T.
        • Macciocchi S.
        • Velozo C.A.
        • et al.
        The safety assessment measure for persons with traumatic brain injury: item pool development and content validity.
        Neurorehabilitation. 2016; 39: 371-387
        • Seel R.T.
        • Wright G.
        • Wallace T.
        • Newman S.
        • Dennis L.
        The utility of the FIM+FAM for assessing traumatic brain injury day program outcomes.
        J Head Trauma Rehabil. 2007; 22: 267-277
        • Kolakowsky-Hayner S.A.
        • Bellon K.
        • Yang Y.
        Unintentional injuries after TBI: potential risk factors, impacts, and prevention.
        Neurorehabilitation. 2016; 39: 363-370
        • Shepherd-Banigan M.E.
        • Shapiro A.
        • McDuffie J.R.
        • et al.
        Interventions that support or involve caregivers or families of patients with traumatic injury: a systematic review.
        J Gen Intern Med. 2018; 33: 1177-1186
        • Cappa K.A.
        • Conger J.C.
        • Conger A.J.
        Injury severity and outcome: a meta-analysis of prospective studies on TBI outcome.
        Health Psychol. 2011; 30: 542-560
        • Pickelsimer E.E.
        • Selassie A.W.
        • Sample P.L.
        • Heinemann A.W.
        • Gu J.K.
        • Veldheer L.C.
        Unmet service needs of persons with traumatic brain injury.
        J Head Trauma Rehabil. 2007; 22: 1-13
        • Heinemann A.W.
        • Sokol K.
        • Garvin L.
        • Bode R.K.
        Measuring unmet needs and services among persons with traumatic brain injury.
        Arch Phys Med Rehabil. 2002; 83: 1052-1059
        • Turner B.J.
        • Fleming J.
        • Ownsworth T.
        • Cornwell P.
        Perceived service and support needs during transition from hospital to home following acquired brain injury.
        Disabil Rehabil. 2011; 33: 818-829
        • Dahdah M.N.
        • Barnes S.
        • Buros A.
        • et al.
        Variations in inpatient rehabilitation functional outcomes across centers in the traumatic brain injury model systems study and the influence of demographics and injury severity on patient outcomes.
        Arch Phys Med Rehabil. 2016; 97: 1821-1831
        • Arango-Lasprilla J.C.
        • Rosenthal M.
        • DeLuca J.
        • Cifu D.X.
        • Hanks R.
        • Komaroff E.
        Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?.
        Arch Phys Med Rehabil. 2007; 88: 11-18
        • Arango-Lasprilla J.C.
        • Rosenthal M.
        • Deluca J.
        • et al.
        Traumatic brain injury and functional outcomes: does minority status matter?.
        Brain Inj. 2007; 21: 701-708
        • Chang P.-F.J.
        • Ostir G.V.
        • Kuo Y.-F.
        • Granger C.V.
        • Ottenbacher K.J.
        Ethnic differences in discharge destination among older patients with traumatic brain injury.
        Arch Phys Med Rehabil. 2008; 89: 231-236
        • Graham J.E.
        • Radice-Neumann D.M.
        • Reistetter T.A.
        • Hammond F.M.
        • Dijkers M.
        • Granger C.V.
        Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury.
        Arch Phys Med Rehabil. 2010; 91: 43-50
        • Corrigan J.D.
        • Horn S.D.
        • Barrett R.S.
        • et al.
        Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury.
        Arch Phys Med Rehabil. 2015; 96: S209-S221
        • Eum R.S.
        • Seel R.T.
        • Goldstein R.
        • et al.
        Predicting institutionalization after traumatic brain injury inpatient rehabilitation.
        J Neurotrauma. 2015; 32: 280-286
        • Reistetter T.A.
        • Karmarkar A.M.
        • Graham J.E.
        • et al.
        Regional variation in stroke rehabilitation outcomes.
        Arch Phys Med Rehabil. 2014; 95: 29-38
        • Birkmeyer J.D.
        • Sharp S.M.
        • Finlayson S.R.
        • Fisher E.S.
        • Wennberg J.E.
        Variation profiles of common surgical procedures.
        Surgery. 1998; 124: 917-923
        • Kraus L.
        Disability statistics annual report.
        University of New Hampshire, Durham, NH2015 (Available at: https://eric.ed.gov/?id=ED583255. Accessed January 20, 2019)
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4: e296
        • Uniform Data System for Medical Rehabilitation
        About the UDSPRO system.
        (Available at:) (Accessed January 20, 2019)
        • Granger C.V.
        • Markello S.J.
        • Graham J.E.
        • Deutsch A.
        • Reistetter T.A.
        • Ottenbacher K.J.
        The Uniform Data System for Medical Rehabilitation report of patients with traumatic brain injury discharged from rehabilitation programs in 2000–2007.
        Am J Phys Med Rehabil. 2010; 89: 265-278
        • Kane R.L.
        • Radosevich D.M.
        Models and causal thinking. In:.
        Conducting health outcomes research. Jones & Bartlett Publishers, Burlington, MA2010
        • Gupta A.
        • Taly A.B.
        Functional outcome following rehabilitation in chronic severe traumatic brain injury patients: a prospective study.
        Ann Indian Acad Neurol. 2012; 15: 120-124
        • Centers for Medicare & Medicaid Services
        Medicare shared saving program. Quality measure benchmarks for the 2018 and 2019 reporting years.
        (Available at:) (Accessed January 20, 2019)
        • Centers for Medicare & Medicaid Services
        IRF quality reporting program measures information.
        (Available at:)
        • Gunn S.
        • Burgess G.H.
        • Maltby J.
        A factor analysis of functional independence and functional assessment measure scores among focal and diffuse brain injury patients: the importance of bifactor models.
        Arch Phys Med Rehabil. 2018; 99: 1805-1810
        • Yue J.K.
        • Vassar M.J.
        • Lingsma H.F.
        • et al.
        Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury.
        J Neurotrauma. 2013; 30: 1831-1844
        • Centers for Medicare & Medicaid Services
        The Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) training manual.
        Centers for Medicare & Medicaid Services, Baltimore2012
        • Nalder E.
        • Hartman L.
        • Hunt A.
        • King G.
        Traumatic brain injury resiliency model: a conceptual model to guide rehabilitation research and practice.
        Disabil Rehabil. 2019; 41: 2708-2717
        • Clayton R.R.
        • Leukefeld C.G.
        • Donohew L.
        • Bardo M.
        • Harrington N.G.
        Risk and protective factors: a brief review.
        Drugs Soc. 1995; 8: 7-14
        • Cade B.S.
        • Noon B.R.
        A gentle introduction to quantile regression for ecologists.
        Front Ecol Environ. 2003; 1: 412-420
        • Cohen J.
        • Cohen P.
        • West S.G.
        • Aiken L.S.
        Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed.
        Lawrence Erlbaum Associates, Mahwah, NJ2003
        • Chernick M.R.
        Bootstrap methods: a guide for practitioners and researchers, Vol .619.
        John Wiley & Sons, Somerset, NJ2011
        • Liu Y.
        • De A.
        Multiple imputation by fully conditional specification for dealing with missing data in a large epidemiologic study.
        Int J Stat Med Res. 2015; 4: 287-295
        • Dash H.H.
        • Chavali S.
        Management of traumatic brain injury patients.
        Korean J Anesthesiol. 2018; 71: 12-21
        • Patel A.
        • Vieira M.M.C.
        • Abraham J.
        • et al.
        Quality of the development of traumatic brain injury clinical practice guidelines: a systematic review.
        PLoS One. 2016; 11e0161554
        • Eum R.S.
        • Brown A.W.
        • Watanabe T.K.
        • et al.
        Risk factors for institutionalization after traumatic brain injury inpatient rehabilitation.
        J Head Trauma Rehabil. 2017; 32: 158-167
        • Rutkowski L.
        • Gonzalez E.
        • Joncas M.
        • von Davier M.
        International large-scale assessment data: issues in secondary analysis and reporting.
        Educ Res. 2010; 39: 142-151
        • Mendez C.M.
        • Harrington D.W.
        • Christenson P.
        • Spellberg B.
        Impact of hospital variables on case mix index as a marker of disease severity.
        Popul Health Manag. 2014; 17: 28-34
        • Uniform Data System for Medical Rehabilitation
        The FIM® instrument: its background, structure, and usefulness.
        (Available at:) (Accessed January 20, 2019)
        • Ottenbacher K.J.
        • Hsu Y.
        • Granger C.V.
        • Fiedler R.C.
        The reliability of the functional independence measure: a quantitative review.
        Arch Phys Med Rehabil. 1996; 77: 1226-1232