Changes in Patient Demographics and Outcomes in the Inpatient Rehabilitation Facility Traumatic Brain Injury Population from 2002 to 2016: Implications for Patient Care and Clinical Trials
| Autor: | Ross Zafonte, Adam G Lamm, Joseph T. Giacino, Richard Goldstein, Paulette Niewczyk, Jeffrey C. Schneider |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 030506 rehabilitation medicine.medical_specialty Traumatic brain injury medicine.medical_treatment Population Rehabilitation Centers 03 medical and health sciences Age Distribution 0302 clinical medicine Brain Injuries Traumatic Outcome Assessment Health Care Health care medicine Humans In patient education Aged Aged 80 and over Inpatients education.field_of_study Rehabilitation business.industry Patient Selection Recovery of Function Length of Stay Middle Aged Inpatient rehabilitation facility medicine.disease United States Clinical trial Concomitant Emergency medicine Female Neurology (clinical) 0305 other medical science business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurotrauma. 36:2513-2520 |
| ISSN: | 1557-9042 0897-7151 |
| DOI: | 10.1089/neu.2018.6014 |
| Popis: | Initial studies examining patient demographics and outcomes in traumatic brain injury (TBI) suggest a trend toward increasing patient age and decreasing rehabilitation length of stay, but such studies have not been repeated since the passage of healthcare reform legislation, most notably the Affordable Care Act. This study utilized the Uniform Data System for Medical Rehabilitation® (UDSMR) for patients admitted to medical rehabilitation facilities after sustaining a TBI from January 1, 2002 through December 31, 2016. Trends for demographic and medical data were evaluated. In total, 233,843 patients from 1290 facilities were included; mean patient age increased from 54.1 to 64.8 years, rehabilitation length of stay decreased from 19 to 14.5 days, and mean admission Functional Independence Measure® (FIM) decreased from 56.9 to 54.5. Sex and racial distribution remained relatively stable across all years, as did discharge FIM. There was an increase in Medicare patients from 40.7% to 62.1%, a concomitant decrease in commercially insured patients from 29.2% to 15.4%, and a decrease in unreimbursed patients from 7.2% to 2.6% over the course of the study. Based on these data, medical rehabilitation facilities appear to be admitting an older TBI patient population that is less functional on admission and discharging them after shorter rehabilitation lengths of stay. Similar discharge functional status, despite shorter rehabilitation lengths of stay and an older population may suggest a change in the typical mechanism of injury. Many current TBI patients would fail to meet inclusion criteria for post-acute clinical trials in TBI because of their age, and treatments based on such trials may not be generalizable, which has significant implications on both research and clinical care realms within brain injury rehabilitation. |
| Databáze: | OpenAIRE |
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