The Association Between Payer Source and Traumatic Brain Injury Rehabilitation Outcomes: A TBI Model Systems Study.
The Association Between Payer Source and Traumatic Brain Injury Rehabilitation Outcomes: A TBI Model Systems Study.
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付款人来源与创伤性脑损伤康复结果之间的关联：TBI 模型系统研究。
DOI：
10.1097/htr.0000000000000781
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Smith,Michelle
中科院分区：
文献类型：
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作者：
Lequerica,AnthonyH;Sander,AngelleM;Pappadis,MoniqueR;Ketchum,JessicaM;Jaross,Marissa;Kolakowsky-Hayner,Stephanie;Rabinowitz,Amanda;Callender,Librada;Smith,Michelle
目的：研究急性康复的支付者来源，居民家庭收入中位数（MHI）和创伤性脑损伤（TBI）后康复出院的结果之间的关系。设置：急性住院康复设施。参与者：在创伤性脑损伤模型系统（TBIMS）国家数据库中登记的8558名患者，他们在2006年至2019年期间接受住院康复治疗，年龄小于64岁。设计：多中心纵向队列研究的次要数据分析。主要措施：支付者来源分为4类：未保险，公共保险，私人保险和工人赔偿/汽车。研究了支付者来源与居民MHI、康复住院时间（RLOS）和出院时的医疗器械之间的关系。协变量包括年龄，受伤的严重程度，入院时，和一些社会人口特征，包括少数民族的地位，受伤前的限制，教育水平，和employment status.Results：个人与工人的赔偿/汽车或私人保险有较长的RLOS比未投保的个人或那些与公共保险后，控制人口统计学和受伤的特点。一个调整后的模型控制人口统计学和伤害特征显示，支付者来源对出院时的TBI评分有显著的主要影响，其中最高的评分出现在工人赔偿/汽车保险的人群中。将RLOS作为协变量加入模型后，支付者来源对住院患者出院的主效应变得不显著，表明RLOS具有中介效应。结论：支付者来源与伤前居民MHI和预测RLOS相关。虽然先前的研究已经证明了由于缺乏住院康复或高质量的后续护理，付款人来源对长期结果的影响，但本研究表明，没有保险或有公共保险的TBI患者在康复出院时可能面临更差的功能状态的风险比那些有私人保险的人，特别是与工人赔偿/汽车保险相比。这种影响可能在很大程度上是由于急性康复期的住院时间较短。
Objective:To examine the relationship between payer source for acute rehabilitation, residential median household income (MHI), and outcomes at rehabilitation discharge after traumatic brain injury (TBI).Setting:Acute inpatient rehabilitation facilities.Participants:In total, 8558 individuals enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who were admitted to inpatient rehabilitation between 2006 and 2019 and were younger than 64 years.Design:Secondary data analysis from a multicenter longitudinal cohort study.Main Measures:Payer source was divided into 4 categories: uninsured, public insurance, private insurance, and workers' compensation/auto. Relationships between payer source with residential MHI, rehabilitation length of stay (RLOS), and the FIM Instrument at discharge were examined. Covariates included age, injury severity, FIM at admission, and a number of sociodemographic characteristics including minority status, preinjury limitations, education level, and employment status.Results:Individuals with workers' compensation/auto or private insurance had longer RLOS than uninsured individuals or those with public insurance after controlling for demographics and injury characteristics. An adjusted model controlling for demographics and injury characteristics showed a significant main effect of payer source on FIM scores at discharge, with the highest scores noted among those with workers' compensation/auto insurance. The main effect of payer source on FIM at discharge became nonsignificant after RLOS was added to the model as a covariate, suggesting a mediating effect of RLOS.Conclusion:Payer source was associated with preinjury residential MHI and predicted RLOS. While prior studies have demonstrated the effect of payer source on long-term outcomes due to lack of inpatient rehabilitation or quality follow-up care, this study demonstrated that individuals with TBI who are uninsured or have public insurance may be at risk for poorer functional status at the point of rehabilitation discharge than those with private insurance, particularly compared with those with workers' compensation/auto insurance. This effect may be largely driven by having a shorter length of stay in acute rehabilitation.