Marie N Dahdah1, Sunni Barnes2, Amy Buros2, Rosemary Dubiel3, Cynthia Dunklin4, Librada Callender4, Caryn Harper4, Amy Wilson5, Ramon Diaz-Arrastia6, Thomas Bergquist7, Mark Sherer8, Gale Whiteneck9, Christopher Pretz10, Rodney D Vanderploeg11, Shahid Shafi12. 1. Baylor Institute for Rehabilitation, Dallas, TX; North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Center for Medical Psychology, Baylor Regional Medical Center of Plano, Plano, TX. 2. Baylor Institute for Health Care Research and Improvement, Dallas, TX. 3. Baylor Institute for Rehabilitation, Dallas, TX; North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX. 4. North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX. 5. Baylor Institute for Rehabilitation, Dallas, TX. 6. North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Uniformed Services University of Health Science, Bethesda, MD. 7. Mayo Clinic Traumatic Brain Injury Model System, Rochester, MN. 8. TIRR Memorial Hermann, Houston, TX. 9. Rocky Mountain Regional Brain Injury System, Englewood, CO. 10. National Data and Statistical Center/Craig Hospital, Englewood, CO. 11. James A. Haley Veterans Hospital, Tampa, FL. 12. North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Baylor Institute for Health Care Research and Improvement, Dallas, TX. Electronic address: shahid.shafi@baylorhealth.edu.
Abstract
OBJECTIVE: To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. DESIGN: Multicenter observational cohort study. SETTING: TBIMS centers. PARTICIPANTS: Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003-2012 (N=5505). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes of patients with TBI. RESULTS: Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. CONCLUSIONS: Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.
OBJECTIVE: To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. DESIGN: Multicenter observational cohort study. SETTING:TBIMS centers. PARTICIPANTS: Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003-2012 (N=5505). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes of patients with TBI. RESULTS: Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. CONCLUSIONS: Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.
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