Successful Community Discharge Among Older Adults With Traumatic Brain Injury in Skilled Nursing Facilities

Abstract

Objective: To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). Setting: Skilled nursing facilities. Participants: Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. Design: Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach. Main Outcome Measure: Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility. Results: Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race "other" was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fallrelated injury mechanism were not associated with successful discharge. Conclusion: Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post-acute care.

Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury

“…These findings are consistent with literature reporting no difference in inpatient rehabilitation outcomes among patients of racial or ethnic minority backgrounds and white patients 47,48 . However, our findings contrast with other evidence suggesting worse functional and community integration outcomes among patients with TBI in minority groups 21,48‐51 and lower likelihood of successful community discharge among dual Medicare and Medicaid enrolled older adults with TBI in SNFs 26 . Our findings suggest that once patients are admitted to an IRF, those who are dually‐enrolled or are of a minority racial or ethnic group have a similar likelihood of improvement.…”

“…47,48 However, our findings contrast with other evidence suggesting worse functional and community integration outcomes among patients with TBI in minority groups 21,[48][49][50][51] and lower likelihood of successful community discharge among dual Medicare and Medicaid enrolled older adults with TBI in SNFs. 26 Our findings suggest that once patients are admitted to an IRF, those who are dually-enrolled or are of a minority racial or ethnic group have a similar likelihood of improvement. However, the limited representation of patients in our sample who were dually-enrolled in Medicare and Medicaid, or of a racial or ethnic minority group should be noted, particularly in light of evidence suggesting differences in access to intensive rehabilitation services among these patient groups.…”

“…The algorithm iterates between the two steps, resulting in simultaneous linking of trauma centers (block‐level) and individual patients (record‐level). This method was previously used to link data from the NTDB to the Medicare administrative data for individuals receiving care in SNFs following TBI and improves the linkages over other Bayesian record linkage approaches 25,26 . In this study we included only trauma centers with burn beds, (ie, facilities with beds dedicated to the care of individuals with burns) identified in the NTDB or AHA survey to limit the number of potential facilities and increase the accuracy of the linkage.…”

“…This method was previously used to link data from the NTDB to the Medicare administrative data for individuals receiving care in SNFs following TBI and improves the linkages over other Bayesian record linkage approaches. 25,26 In this study we included only trauma centers with burn beds, (ie, facilities with beds dedicated to the care of individuals with burns) identified in the NTDB or AHA survey to limit the number of potential facilities and increase the accuracy of the linkage. We accounted for potential linking errors (i.e., linking records that represent different entities or not linking records of the same entity), by generating 29 datasets in which the latent linkage structure was imputed using samples from the posterior distribution of the linkage algorithm.…”

The impact of facility-based transitional care programs on function and discharge destination for older adults with cognitive impairment: a systematic review

“…Disagreements between individual judgments were resolved by discussion and consensus. Authors [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] were contacted to ascertain any required information that was missing or unclear and data provided directly by the authors [29,30,47] was included in this review (See PRISMA diagram, Fig. 1).…”