A simulation study on the US rehabilitation service process for patients with modest-to-severe traumatic brain injury

Abstract

Traumatic brain injury (TBI) is a devastating injury with severe consequences. In this paper, we conduct a simulation study on the commonly implemented care delivery process for TBI rehabilitation in the US, which covers three care categories: inpatient acute, outpatient sub-acute and general residential care. Our investigation is focused on assessing how coverage duration of publicly funded rehabilitation impacts two key system outcomes: sub-acute rehabilitation readmission and total rehabilitation spending. We develop prediction models on the above two outcomes for patients of different conditions. We introduce the notions of forceful transition and medical necessity adjustment, and embed the notions in a state-transition simulation model. Our simulation results suggest that to minimise the care spending, the duration of publicly insured outpatient sub-acute rehab be set smaller than what is currently implemented but not to the point where coverage should be completely removed. Our sensitivity analysis justifies the robustness of our results under variations on model parameters.