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The Association Between Payer Source and Traumatic Brain Injury Rehabilitation Outcomes: A TBI Model Systems Study.

Anthony H Lequerica1, Angelle M Sander, Monique R Pappadis

  • 1Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey (Dr Lequerica); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Drs Sander and Pappadis); Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston (Dr Pappadis); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum and Ms Jaross); Magellan Federal, Silver Springs, Maryland (Dr Kolakowsky-Hayner); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Rabinowitz); Research Department, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Ms Callender); and Department of Research, NYU Grossman School of Medicine, New York City, New York (Ms Smith).

The Journal of Head Trauma Rehabilitation
|April 22, 2022
PubMed
Summary

Individuals with traumatic brain injury (TBI) and public or no insurance may experience worse outcomes due to shorter rehabilitation lengths of stay. Workers' compensation/auto insurance is linked to better functional status post-rehabilitation.

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Health Services Research

Background:

  • Traumatic brain injury (TBI) significantly impacts individuals, necessitating acute inpatient rehabilitation.
  • Understanding factors influencing rehabilitation outcomes is crucial for patient recovery and healthcare planning.
  • Payer source and socioeconomic status are potential determinants of access to and quality of rehabilitation care.

Purpose of the Study:

  • To investigate the association between the payer source for acute rehabilitation, residential median household income (MHI), and functional outcomes at discharge following TBI.
  • To explore how payer source relates to rehabilitation length of stay (RLOS) and functional independence measure (FIM) scores post-TBI.

Main Methods:

  • Secondary data analysis of 8558 individuals from the Traumatic Brain Injury Model Systems (TBIMS) National Database (2006-2019).
  • Participants were younger than 64 years and admitted to inpatient rehabilitation.
  • Payer source (uninsured, public, private, workers' compensation/auto) was analyzed against MHI, RLOS, and FIM scores, controlling for demographic and injury characteristics.

Main Results:

  • Individuals with workers' compensation/auto or private insurance had significantly longer RLOS compared to uninsured or publicly insured individuals.
  • Payer source significantly affected FIM scores at discharge, with workers' compensation/auto insurance yielding the highest scores.
  • The influence of payer source on FIM scores became non-significant when RLOS was included, indicating RLOS mediates the relationship.

Conclusions:

  • Payer source is linked to pre-injury residential MHI and predicts RLOS in TBI patients.
  • Uninsured or publicly insured TBI patients may face poorer functional status at rehabilitation discharge, potentially due to shorter lengths of stay.
  • Rehabilitation length of stay appears to be a key factor mediating the impact of payer source on functional outcomes after TBI.