Emily Evans1, Roee Gutman, Linda Resnik, Mark R Zonfrillo, Stephanie N Lueckel, Raj G Kumar, Frank DeVone, Kristen Dams-O'Connor, Kali S Thomas. 1. Department of Health Services, Policy and Practice Center for Gerontology and Healthcare Research, Brown School of Public Health (Drs Evans, Resnik, and Thomas) and Department of Biostatistics (Dr Gutman and Mr DeVone), Brown University School of Public Health, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island (Drs Resnik and Thomas); Departments of Emergency Medicine and Pediatrics (Dr Zonfrillo) and Division of Acute Care Surgery and Surgical Critical Care, Rhode Island Hospital (Dr Lueckel), Warren Alpert School of Medicine of Brown University, Providence, Rhode Island; and Department of Rehabilitation and Human Performance (Drs Kumar and Dams-O'Connor) and Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York.
Abstract
OBJECTIVE: To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). SETTING: Skilled nursing facilities. PARTICIPANTS: Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. DESIGN: Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach. MAIN OUTCOME MEASURE: Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility. RESULTS: Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race "other" was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fall-related injury mechanism were not associated with successful discharge. CONCLUSION: Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post-acute care.
OBJECTIVE: To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). SETTING: Skilled nursing facilities. PARTICIPANTS: Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. DESIGN: Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach. MAIN OUTCOME MEASURE: Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility. RESULTS: Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race "other" was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fall-related injury mechanism were not associated with successful discharge. CONCLUSION: Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post-acute care.
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