Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation
Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation
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DOI：
10.1016/j.apmr.2017.11.016
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发表时间：
2018-11-01
影响因子：
4.3
通讯作者：
Bushnik, Tamara
中科院分区：
文献类型：
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作者：
Kucukboyaci, N. Erkut;Long, Coralynn;Bushnik, Tamara
目的：分析影响社会经济地位的各种社会指标与卫生保健障碍之间的复杂关系。设计：对住院患者的历史数据进行聚类分析。地点：一所大型城市大学医院的住院康复室。参与者：148名接受急性住院治疗的成年患者，主要是闭合性头部损伤。干预措施：不适用。主要观察指标：我们调查了不同弱势群体(如无家可归、失业、种族/少数民族)中创伤性脑损伤患者的成员情况，并表征了患者的康复结果(如，住院时间，从入院到出院期间FIM评分的变化)。结果：聚类分析显示，由弱势群体成员划分的4个主要类(即A-D类)具有不同的住院时间和FIM收益。B组是最大的组，也主要由种族/少数民族组成，尽管入院时FIM评分较高，但B组住院时间最短，FIM改善程度也是4个组中最低的之一。在C组中，患者入院时认知FIM评分较低，住院时间最长，且FIM评分有较好的改善。结论：应用聚类技术对住院患者数据进行分析，确定了不同类别的患者，由于他们属于不同的“高危”群体，可能会经历不同的康复结果。结果确定了在脑损伤康复方面取得低于平均水平的收益的患者(即，B组，少数族裔患者；D组，老年患者)。结果还表明，系统性的(例如，住院时间)或临床服务的改善(例如，工作人员的语言技能、提供药物滥用治疗的能力、提供适当的转介、与密集社会工作服务的联系，或计划亚急性康复阶段)可能对急性环境有益。加强对双语和多种族专业人员的招聘、培训和留住工作，也可以考虑优化创伤性脑损伤后急性住院康复的收益。(C)2017年由美国康复医学大会公布。
Objective: To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.Design: Cluster analysis of historical patient data obtained from inpatient visits.Setting: Inpatient rehabilitation unit in a large urban university hospital.Participants: Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury.Interventions: Not applicable.Main Outcome Measures: We examined the membership of patients with traumatic brain injury in various "vulnerable group" clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge).Results: The cluster analysis revealed 4 major clusters (ie, clusters A-D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.Conclusions: Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training, and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation after traumatic brain injury. (C) 2017 by the American Congress of Rehabilitation Medicine.