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Investigating Disparities in Acute Rehabilitation Outcomes Among Individuals With TBI and SCI: A Retrospective Chart
Elizabeth C Pasipanodya1, Benjamin Dirlikov1, Tene A Cage2,3
1Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA.
Objective:
To examine the influence of multiple sociodemographic characteristics (sex, race/ethnicity, insurance type, and community socioeconomic status [SES]) on inpatient rehabilitation outcomes among individuals with traumatic brain injury (TBI) and spinal cord injury (SCI).
Design:
Retrospective chart review.
Setting:
Acute inpatient rehabilitation at a level 1 trauma hospital.
Participants:
Participants meeting the inclusion criteria were individuals with (1) acute inpatient rehabilitation admission to our rehabilitation center between January 1, 2008, and December 31, 2020, (2) with traumatic SCI or TBI as their primary rehabilitation diagnosis, and (3) aged ≥18 years. A total of 1756 individuals (890 TBI and 866 SCI) were included in analyses.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcomes were FIM at discharge, total length of stay (LOS), and discharge disposition ("Acute," "Other Rehabilitation/Long-term Facility," and "Home"). Focal predictors were sex, race/ethnicity, insurance payor, and community SES.
Results:
In uncontrolled analyses, individuals from communities with higher SES had higher discharge FIM scores, shorter LOS, and higher rates of discharge to other rehabilitation or long-term facilities. Those with workers' compensation had significantly longer LOS than those with commercial insurance. Discharge FIM scores were highest among individuals with workers' compensation, followed by those with commercial and then public insurance. In multivariate analyses that accounted for relevant covariates and other focal sociodemographic factors, only insurance type was significantly associated with discharge outcomes. Specifically, individuals with workers' compensation had a longer LOS than those with commercial insurance and were more likely to be discharged to an acute care setting rather than home. Furthermore, individuals with public insurance had lower FIM scores than those with commercial insurance.
Conclusions:
Beyond the relevant medical and sociodemographic factors, insurance type is a significant predictor of disparities in rehabilitation outcomes. Future work should examine outcomes at each cascade of the trauma care continuum and the moderators of these effects to understand social determinants of health.