Factors Associated with Unsuccessful Admissions to Inpatient Rehabilitation Facilities Among Older Adults With Traumatic Brain Injury

Abstract

Research Objectives Older adults comprise a growing proportion of patients with TBI in inpatient rehabilitation facilities (IRF). However, concerns about their tolerance of rehabilitation-intensive IRF care remain. Centers for Medicare & Medicaid defined ‘short stays’ (Length of stay (LOS) < 3 days) and ‘short-stay transfers’ (transfers to an institutional setting with a shorter than expected LOS) suggest a limited benefit from an IRF admission. Our objective is to examine the relationship between age, chronic conditions, functional status, and the odds of an ‘unsuccessful IRF admission’ among older adults with TBI. Design In this retrospective cohort study we used Medicare administrative data linked to the National Trauma Data Bank via a Bayesian record linkage algorithm to examine the relationship between age, chronic conditions, functional status, and an ‘unsuccessful IRF admission.’ We used a two-level hierarchical logistic regression model, adjusting for demographics, injury characteristics, and facility effects. Setting U.S. Inpatient Rehabilitation Facilities. Participants Medicare fee-for-service beneficiaries hospitalized with TBI between 2011 and 2015. Interventions N/A. Main Outcome Measures Unsuccessful IRF admission (‘short stays’ or ‘short-stay transfers’). Results Cognitive function in the lowest quartile (OR:2.5 (1.0, 6.3), or motor function in the lowest two quartiles (OR:3.1(1.4, 7.1), OR:6.2 (2.4, 15.6)) were associated with higher odds of an ‘unsuccessful IRF admission’ compared to the highest quartile of each domain. The model differentiated ‘unsuccessful IRF admissions’ (AUC:0.74 (0.69, 0.80), however, 46% of those in cognitive quartile 1, and 52% of those in motor quartiles 1 and 2 were able to discharge home. Conclusions Among older adults with TBI, significant impairments in cognitive and motor function are associated with increased risk of an ‘unsuccessful IRF admission’. Factors unaccounted for in our models, potentially acute management characteristics, may help to differentiate those who are unlikely to benefit from IRF care. Author(s) Disclosures Co-Author Roee Gutman has served as an expert witness for Johnson & Johnson. The authors have no other conflicts of interest to report. Older adults comprise a growing proportion of patients with TBI in inpatient rehabilitation facilities (IRF). However, concerns about their tolerance of rehabilitation-intensive IRF care remain. Centers for Medicare & Medicaid defined ‘short stays’ (Length of stay (LOS) < 3 days) and ‘short-stay transfers’ (transfers to an institutional setting with a shorter than expected LOS) suggest a limited benefit from an IRF admission. Our objective is to examine the relationship between age, chronic conditions, functional status, and the odds of an ‘unsuccessful IRF admission’ among older adults with TBI. In this retrospective cohort study we used Medicare administrative data linked to the National Trauma Data Bank via a Bayesian record linkage algorithm to examine the relationship between age, chronic conditions, functional status, and an ‘unsuccessful IRF admission.’ We used a two-level hierarchical logistic regression model, adjusting for demographics, injury characteristics, and facility effects. U.S. Inpatient Rehabilitation Facilities. Medicare fee-for-service beneficiaries hospitalized with TBI between 2011 and 2015. N/A. Unsuccessful IRF admission (‘short stays’ or ‘short-stay transfers’). Cognitive function in the lowest quartile (OR:2.5 (1.0, 6.3), or motor function in the lowest two quartiles (OR:3.1(1.4, 7.1), OR:6.2 (2.4, 15.6)) were associated with higher odds of an ‘unsuccessful IRF admission’ compared to the highest quartile of each domain. The model differentiated ‘unsuccessful IRF admissions’ (AUC:0.74 (0.69, 0.80), however, 46% of those in cognitive quartile 1, and 52% of those in motor quartiles 1 and 2 were able to discharge home. Among older adults with TBI, significant impairments in cognitive and motor function are associated with increased risk of an ‘unsuccessful IRF admission’. Factors unaccounted for in our models, potentially acute management characteristics, may help to differentiate those who are unlikely to benefit from IRF care.