Geographic Variation in Inpatient Rehabilitation Outcomes After Traumatic Brain Injury.
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| Title: | Geographic Variation in Inpatient Rehabilitation Outcomes After Traumatic Brain Injury. |
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| Authors: | Darji N; Author Affiliations: Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Darji); Department of Physical Medicine and Rehabilitation, Atrium Health Carolinas Rehabilitation, Charlotte, North Carolina (Dr Darji); Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (Dr Zhang); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, Massachusetts (Drs Goldstein, Shih, Iaccarino, Schneider, and Zafonte); Massachusetts General Hospital, Boston, Massachusetts (Drs Shih, Iaccarino, and Zafonte); and Brigham and Women's Hospital, Boston, Massachusetts (Dr Zafonte)., Zhang B, Goldstein R, Shih SL, Iaccarino MA, Schneider JC, Zafonte R |
| Source: | The Journal of head trauma rehabilitation [J Head Trauma Rehabil] 2025 Jul-Aug 01; Vol. 40 (4), pp. E292-E299. Date of Electronic Publication: 2025 Jan 03. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Aspen Publications Country of Publication: United States NLM ID: 8702552 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1550-509X (Electronic) Linking ISSN: 08859701 NLM ISO Abbreviation: J Head Trauma Rehabil Subsets: MEDLINE |
| Imprint Name(s): | Publication: Gaithersburg Md : Aspen Publications Original Publication: [Gaithersburg, Md.] : Aspen, [c1986- |
| MeSH Terms: | Brain Injuries, Traumatic*/rehabilitation , Rehabilitation Centers*/statistics & numerical data, Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adult ; United States ; Patient Discharge/statistics & numerical data ; Inpatients/statistics & numerical data ; Recovery of Function ; Aged ; Treatment Outcome |
| Abstract: | Objective: To determine whether regional variations exist in functional outcomes of patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation facilities (IRFs) across the United States, while controlling for demographic and clinical variables. Setting: Inpatient rehabilitation facilities (IRFs) across 4 U.S. regions: West, Midwest, South, and East. Participants: Adult patients with open or closed TBI (Rehabilitation Impairment Codes 2.21 or 2.22) discharged from an IRF between 2016 and 2019. Design: This is a retrospective analysis de-identified data from the Uniform Data System for Medical Rehabilitation. The study compared total functional independence measure (FIM) scores and discharge dispositions across the 4 regions. Main Measures: Primary outcomes were FIM scores at discharge, changes in FIM scores between admission and discharge, and community discharge rates, adjusted for demographic and clinical factors. Cohen's d effect sizes were calculated to assess the clinical significance of regional differences on FIM scores. Prevalence ratios were used for discharge disposition outcomes. Results: Regional differences were identified in functional outcomes for patients with TBI. The West had the highest community discharge rate (80.9%) compared to the East (70.5%). Discharge FIM scores were significantly lower in the Midwest and East compared to the South (-1.98 and - 2.31, respectively, P < .01), while the West showed no significant difference from the South (-0.78, P = .11). Effect sizes for FIM total scores were small across regions, with Cohen's d for West versus South at 0.017, Midwest versus South at 0.047, and East versus South at 0.047. Prevalence ratios for community discharge showed minor differences: West versus South at 1.010, Midwest versus South at 0.937, and East versus South at 0.918; all without statistical significance. Conclusions: Regional disparities in functional outcomes following inpatient rehabilitation for TBI were observed, particularly in community discharge rates and total FIM scores. However, based on the effect sizes and prevalence ratios, these differences may not be clinically meaningful and could not be fully explained by demographic and clinical factors. Further studies are needed to explore region-specific factors influencing rehabilitation efficacy to improve outcomes for patients with TBI nationwide. (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.) |
| References: | Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the united states emergency department visits, hospitalizations and deaths 2002-2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. De Koning ME, Spikman JM, Coers A, Schönherr MC, 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(4):423–429. doi:10.3109/02699052.2014.982188. (PMID: 10.3109/02699052.2014.982188) Dahdah MN, 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(11):1821–1831. doi:10.1016/j.apmr.2016.05.005. (PMID: 10.1016/j.apmr.2016.05.005) Kunik CL, Flowers L, Kazanjian T. Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury. Arch Phys Med Rehabil. 2006;87(12):1590–1596. doi:10.1016/j.apmr.2006.09.001. (PMID: 10.1016/j.apmr.2006.09.001) Dams-O’Connor K, Ketchum JM, Cuthbert JP, et al. Functional outcome trajectories following inpatient rehabilitation for TBI in the United States: a NIDILRR TBIMS and CDC Interagency Collaboration. J Head Trauma Rehabil. 2020;35(2):127–139. doi:10.1097/HTR.0000000000000484. (PMID: 10.1097/HTR.0000000000000484) Thompson HJ, Dikmen S, Temkin N. Prevalence of comorbidity and its association with traumatic brain injury and outcomes in older adults. Res Gerontol Nurs. 2012;5(1):17–24. doi:10.3928/19404921-20111206-02. (PMID: 10.3928/19404921-20111206-02) Corrigan JD, Horn SD, Barrett RS, et al. Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury. Arch Phys Med Rehabil. 2015;96(8):S209–S221.e6. doi:10.1016/j.apmr.2015.03.026. (PMID: 10.1016/j.apmr.2015.03.026) Lew HL, Lee E, Date ES, Zeiner H. Influence of medical comorbidities and complications on FIM TM change and length of stay during inpatient rehabilitation. Am J Phys Med Rehabil. 2002;81(11):830–837. doi:10.1097/00002060-200211000-00005. (PMID: 10.1097/00002060-200211000-00005) Brown AW, Malec JF, McClelland RL, Diehl NN, Englander J, Cifu DX. Clinical elements that predict outcome after traumatic brain injury: a prospective multicenter recursive partitioning (decision-tree) analysis. J Neurotrauma. 2005;22(10):1040–1051. doi:10.1089/neu.2005.22.1040. (PMID: 10.1089/neu.2005.22.1040) Oyesanya TO, Harris G, Cary MP, Byom L, Yang Q, Bettger JP. Age- and sex-specific predictors of inpatient rehabilitation facility discharge destination for adult patients with traumatic brain injury. Brain Inj. 2021;35(12-13):1529–1541. doi:10.1080/02699052.2021.1972453. (PMID: 10.1080/02699052.2021.1972453) Oyesanya TO, Moran TP, Espinoza TR, Wright DW. Regional variations in rehabilitation outcomes of adult patients with traumatic brain injury: a uniform data system for medical rehabilitation investigation. Arch Phys Med Rehabil. 2021;102(1):68–75. doi:10.1016/j.apmr.2020.07.011. (PMID: 10.1016/j.apmr.2020.07.011) Daugherty J, Zhou H, Sarmiento K, Waltzman D. Differences in state traumatic brain injury–related deaths, by principal mechanism of injury, intent, and percentage of population living in rural areas—United States, 2016–2018. MMWR Morb Mortal Wkly Rep. 2021;70(41):1447–1452. doi:10.15585/mmwr.mm7041a3. (PMID: 10.15585/mmwr.mm7041a3) Granger CV, Markello SJ, Graham JE, Deutsch A, Reistetter TA, Ottenbacher KJ. 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(4):265–278. doi:10.1097/PHM.0b013e3181d3eb20. (PMID: 10.1097/PHM.0b013e3181d3eb20) Center for Medicare and Medicaid Services: regional offices. Accessed January 14, 2024. http://www.cms.gov/About-CMS/Agency-Inforation/RegionalOffices/Index.html . Abayomi K, Gelman A, Levy M. Diagnostics for multivariate imputations. Published online 2024. Von Hippel PT. How many imputations do you need? A two-stage calculation using a quadratic rule. Sociol Methods Res. 2020;49(3):699–718. doi:10.1177/0049124117747303. (PMID: 10.1177/0049124117747303) Cleveland WS. Robust locally weighted regression and smoothing scatterplots. J Am Stat Assoc. 1979;74(368):829–836. doi:10.1080/01621459.1979.10481038. (PMID: 10.1080/01621459.1979.10481038) Sullivan GM, Feinn R. Using effect size—or why the P value is not enough. J Grad Med Educ. 2012;4(3):279–282. doi:10.4300/JGME-D-12-00156.1. (PMID: 10.4300/JGME-D-12-00156.1) Shaw BP. Effect sizes for contrasts of estimated marginal effects. Stata J Promot Commun Stat Stata. 2022;22(1):134–157. doi:10.1177/1536867X221083901. (PMID: 10.1177/1536867X221083901) Cohen J. A power primer. Psychol Bull. 1992;112(1):155–159. doi:10.1037/0033-2909.112.1.155. (PMID: 10.1037/0033-2909.112.1.155) Arcolin I, Godi M, Giardini M, Guglielmetti S, Bellotti L, Corna S. Minimal clinically important difference of the functional independence measure in older adults with hip fracture. Disabil Rehabil. Published online February 7. 2023:1–8. doi:10.1080/09638288.2023.2175386. (PMID: 10.1080/09638288.2023.2175386) Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil. 2006;87(1):32–39. doi:10.1016/j.apmr.2005.08.130. (PMID: 10.1016/j.apmr.2005.08.130) Hall KM, Mann N, High WM, Wright J, Kreutzer JS, Wood D. Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS, and CIQ. J Head Trauma Rehabil. 1996;11(5):27–39. doi:10.1097/00001199-199610000-00004. (PMID: 10.1097/00001199-199610000-00004) Reistetter TA, Karmarkar AM, Graham JE, et al. Regional variation in stroke rehabilitation outcomes. Arch Phys Med Rehabil. 2014;95(1):29–38. doi:10.1016/j.apmr.2013.07.018. (PMID: 10.1016/j.apmr.2013.07.018) Camp D. H.R. 4994 Improving Medicare Post-Acute Care Transformation Act of 2014; 2014. Cary MP, Prvu Bettger J, Jarvis JM, Ottenbacher KJ, Graham JE. Successful community discharge following postacute rehabilitation for medicare beneficiaries: analysis of a patient‐centered quality measure. Health Serv Res. 2018;53(4):2470–2482. doi:10.1111/1475-6773.12796. (PMID: 10.1111/1475-6773.12796) Corrigan JD, Vuolo M, Bogner J, Botticello AL, Pinto SM, Whiteneck GG. Do state supports for persons with brain injury affect outcomes in the 5 years following acute rehabilitation? Health Place. 2021;72:102674. doi:10.1016/j.healthplace.2021.102674. (PMID: 10.1016/j.healthplace.2021.102674) Sander AM, Caroselli JS Jr. WMH, Becker C, Neese L, Scheibel R. Relationship of family functioning to progress in a post-acute rehabilitation programme following traumatic brain injury. Brain Inj. 2002;16(8):649–657. doi:10.1080/02699050210128889. (PMID: 10.1080/02699050210128889) Laurence FMS. Functional status following traumatic brain injuries: population-based rural-urban differences. Brain Inj. 1999;13(12):995–1004. doi:10.1080/026990599121007. (PMID: 10.1080/026990599121007) Gontkovsky ST, Sherer M, Nick TG, Nakase-Thompson R, Yablon SA. Effect of urbanicity of residence on TBI outcome at one year post-injury. Brain Inj. 2006;20(7):701–709. doi:10.1080/02699050600744103. (PMID: 10.1080/02699050600744103) Johnstone B, Price T, Bounds T, Schopp LH, Schootman M, Schumate D. Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI. NeuroRehabilitation. 2003;18(3):197–203. Corrigan JD, Bogner JA. Neighborhood characteristics and outcomes after traumatic brain injury. Arch Phys Med Rehabil. 2008;89(5):912–921. doi:10.1016/j.apmr.2007.12.027. (PMID: 10.1016/j.apmr.2007.12.027) Vaughn S. State programs and services for individuals with traumatic brain injury (TBI) and their families. Published online June 2015. Middleton A, Graham JE, Prvu Bettger J, Haas A, Ottenbacher KJ. Facility and geographic variation in rates of successful community discharge after inpatient rehabilitation among medicare fee-for-service beneficiaries. JAMA Netw Open. 2018;1(7):e184332. doi:10.1001/jamanetworkopen.2018.4332. (PMID: 10.1001/jamanetworkopen.2018.4332) Lamm AG, Goldstein R, Slocum CS, et al. For-profit and not-for-profit inpatient rehabilitation in traumatic brain injury: analysis of demographics and outcomes. Arch Phys Med Rehabil. 2022;103(5):851–857. doi:10.1016/j.apmr.2021.11.003. (PMID: 10.1016/j.apmr.2021.11.003) Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994;75(2):127–132. doi:10.1016/0003-9993(94)90384-0. (PMID: 10.1016/0003-9993(94)90384-0) MapChart. Accessed August 25, 2024. www.mapchart.net. |
| Contributed Indexing: | Keywords: functional status; health care; health policy; inpatients; outcome assessment; regional health planning; rehabilitation; traumatic brain injuries |
| Entry Date(s): | Date Created: 20250103 Date Completed: 20250708 Latest Revision: 20250708 |
| Update Code: | 20250708 |
| DOI: | 10.1097/HTR.0000000000001033 |
| PMID: | 39750287 |
| Database: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Objective: To determine whether regional variations exist in functional outcomes of patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation facilities (IRFs) across the United States, while controlling for demographic and clinical variables.<br />Setting: Inpatient rehabilitation facilities (IRFs) across 4 U.S. regions: West, Midwest, South, and East.<br />Participants: Adult patients with open or closed TBI (Rehabilitation Impairment Codes 2.21 or 2.22) discharged from an IRF between 2016 and 2019.<br />Design: This is a retrospective analysis de-identified data from the Uniform Data System for Medical Rehabilitation. The study compared total functional independence measure (FIM) scores and discharge dispositions across the 4 regions.<br />Main Measures: Primary outcomes were FIM scores at discharge, changes in FIM scores between admission and discharge, and community discharge rates, adjusted for demographic and clinical factors. Cohen's d effect sizes were calculated to assess the clinical significance of regional differences on FIM scores. Prevalence ratios were used for discharge disposition outcomes.<br />Results: Regional differences were identified in functional outcomes for patients with TBI. The West had the highest community discharge rate (80.9%) compared to the East (70.5%). Discharge FIM scores were significantly lower in the Midwest and East compared to the South (-1.98 and - 2.31, respectively, P < .01), while the West showed no significant difference from the South (-0.78, P = .11). Effect sizes for FIM total scores were small across regions, with Cohen's d for West versus South at 0.017, Midwest versus South at 0.047, and East versus South at 0.047. Prevalence ratios for community discharge showed minor differences: West versus South at 1.010, Midwest versus South at 0.937, and East versus South at 0.918; all without statistical significance.<br />Conclusions: Regional disparities in functional outcomes following inpatient rehabilitation for TBI were observed, particularly in community discharge rates and total FIM scores. However, based on the effect sizes and prevalence ratios, these differences may not be clinically meaningful and could not be fully explained by demographic and clinical factors. Further studies are needed to explore region-specific factors influencing rehabilitation efficacy to improve outcomes for patients with TBI nationwide.<br /> (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.) |
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| ISSN: | 1550-509X |
| DOI: | 10.1097/HTR.0000000000001033 |