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For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes

  • Author Footnotes
    + Dr. Lamm was affiliated with Spaulding Rehab Hospital during data collection, and Mary Free Bed at the time of publication
    Adam G. Lamm
    Footnotes
    + Dr. Lamm was affiliated with Spaulding Rehab Hospital during data collection, and Mary Free Bed at the time of publication
    Affiliations
    Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
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  • Richard Goldstein
    Affiliations
    Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
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  • Chloe S. Slocum
    Affiliations
    Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA

    Massachusetts General Hospital, 55 Fruit Street, Boston, MA
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  • Julie K. Silver
    Affiliations
    Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA

    Massachusetts General Hospital, 55 Fruit Street, Boston, MA

    Brigham & Women's Hospital, 75 Francis Street, Boston, MA
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  • David C. Grabowski
    Affiliations
    Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
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  • Author Footnotes
    ⁎ indicates co-senior authorship
    Jeffrey C. Schneider
    Footnotes
    ⁎ indicates co-senior authorship
    Affiliations
    Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
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  • Ross D. Zafonte
    Correspondence
    Correspondence: Ross Zafonte, DO, 300 First Ave, Charlestown, MA 02129, 617-952-5000
    Affiliations
    Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA

    Massachusetts General Hospital, 55 Fruit Street, Boston, MA

    Brigham & Women's Hospital, 75 Francis Street, Boston, MA
    Search for articles by this author
  • Author Footnotes
    + Dr. Lamm was affiliated with Spaulding Rehab Hospital during data collection, and Mary Free Bed at the time of publication
    ⁎ indicates co-senior authorship
Published:November 28, 2021DOI:https://doi.org/10.1016/j.apmr.2021.11.003

      Abstract

      Objective

      To describe differences in traumatic brain injury patient characteristics and outcomes by inpatient rehabilitation facility profit status.

      Design

      Retrospective database review utilizing the Uniform Data System for Medical Rehabilitation® (UDSMR).

      Setting

      Inpatient rehabilitation facilities.

      Participants

      Individual discharges (n = 53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018.

      Intervention

      NA

      Main Outcome Measures

      Patient demographic data (age, race, primary payer source), admission and discharge Functional Independence Measure® (FIM®), FIM® gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status.

      Results

      Patients at for-profit facilities were significantly older (69.69 vs. 64.12 years), with lower admission FIM® scores (52 vs. 57), shorter lengths of stay (13 vs. 15 days), and higher discharge FIM® scores (88 vs. 86); for-profit facilities had higher rates of community discharges (76.8% vs. 74.6%), but also had higher rates of readmission (10.3% vs. 9.9%).

      Conclusions

      The finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied, to determine if differences in patient selection, coding/billing, or other unreported factors underlie these differences.

      Keywords

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