Social Determinants Of Health And Onset Of Rehabilitation Services Among Individuals With Traumatic Brain Injury

Abstract

<h3>Research Objectives</h3> Early onset of rehabilitation services is associated with functional outcomes at discharge. However, the impact of social determinants of health (SDoH) on early access to acute care rehabilitation services in not well understood. We sought to examine the influence of community-level SDoH on early access to rehabilitation services among individuals with TBI. <h3>Design</h3> In a secondary analysis of de-identified electronic health record (EHR) data, multinomial logistic regression models were computed to calculate odds ratios and 95% confidence intervals for the likelihood of early onset of rehabilitation services. <h3>Setting</h3> 14 regional acute care hospitals. <h3>Participants</h3> 5,812 adults with TBI. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Community-level SDoH (i.e., Median income; Education attainment; Residence location). Onset of rehabilitation services in days (i.e., No Services; Early; Minimally delayed; Delayed). <h3>Results</h3> Multinomial logistic regression models showed that patients living in locations with a median income between $47,500 and $61,069 (vs. median income ≤$47,500) were more likely to receive no OT (OR=1.704, p < .05) and PT services (OR=1.619, p < .05; vs. receiving delayed services). Compared to patients with severe TBI, those with mild or moderate were more likely to receive early access to OT (OR=3.188, p < .05) and PT services (OR=2.793, p < .05; vs. receiving delayed services). Patients with greater comorbidity burden were less likely to have early access to OT (OR=.876, p < .05) and PT services (OR=.870, p < .05; vs. receiving delayed services). Other indicators of community-level SDoH were not associated with onset of rehabilitation services. <h3>Conclusions</h3> Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care, or whether community-level education and income, and rurality truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services. <h3>Author(s) Disclosures</h3> None.