Care patterns and predictors of community residence among older patients after hospital discharge for traumatic brain injury

Abstract

Background An increasing number of older adults with traumatic brain injury (TBI) require hospitalization, but it is unknown whether they return to their community following discharge. We examined community residence following acute hospital discharge for TBI in Texas and identified factors associated with 90‐day community residence and readmission. Methods We conducted a retrospective cohort study using 100% Texas Medicare claims data of patients older than 65 years hospitalized for a TBI from January 1, 2014, through December 31, 2017, and followed for 20 weeks after discharge. Discharges to short‐term and long‐term acute hospital, inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long‐term nursing home (NH), and hospice were identified. The primary outcome was 90‐day community residence. Our secondary outcome was 90‐day, all‐cause readmission. Results In Texas, 26,985 Medicare fee‐for‐service patients were hospitalized for TBI (Racial and ethnic minorities: 21.1%; Females 57.3%). At 90 days and 20 weeks following discharge, 80% and 84% were living in the community respectively. Female sex (OR = 1.16 [1.08–1.25]), Hispanic ethnicity (OR = 2.01 [1.80–2.25]), “other” race (OR = 2.19 [1.73–2.77]), and prior primary care provider (PCP; OR = 1.51 [1.40–1.62]) were associated with increased likelihood of 90‐day community residence. Patients aged 75+, prior NH residence, dual eligibility, prior TBI diagnosis, and moderate‐to‐severe injury severity were associated with decreased likelihood of 90‐day community residence. Being non‐Hispanic Black (HR = 1.33 [1.20–1.46]), discharge to SNF (HR = 1.56 [1.48–1.65]) or IRF (HR = 1.49 [1.40–1.59]), having prior PCP (HR = 1.23 [1.17–1.30]), dual eligibility (HR = 1.11 [1.04–1.18]), and prior TBI diagnosis (HR = 1.05 [1.01–1.10]) were associated with increased risk of 90‐day readmission. Female sex and “other” race were associated with decreased risk of 90‐day readmission. Conclusions Most older adults with TBI return to the community following hospital discharge. Disparities exist in returning to the community and in risk of 90‐day readmission following hospital discharge. Future studies should explore how having a PCP influences post‐hospital outcomes in chronic care management of older patients with TBI.

Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review

“…Different patient populations with various (typically chronic) conditions (eg, dementia [ 18 - 22 ], Alzheimer disease [ 23 ], depressive burden [ 24 ], stroke [ 25 , 52 ], hip fracture [ 26 ], frailty [ 8 , 27 - 29 ], and traumatic brain injury [ 30 , 31 ]) and specific insurance or socioeconomic statuses (eg, Medicare [ 24 , 32 , 33 , 35 ], Medicaid [ 34 , 36 ], or special social support beneficiaries [ 37 ]) were reported. The categorization of older adult populations was not limited to disease categories alone but also included factors related to medical service use and socioeconomic status.…”

“…NHA was defined in different ways across the studies; 6 studies defined admission based on a time period after the receipt of acute care (ie, admission to long-term care at 1 y after first-ever ischemic stroke or intracerebral hemorrhage [ 25 ]; admission to a nursing home within 1 y of discharge from hip fracture surgery [ 26 ]; NHA at 90 d outside of acute care [ 38 ]; 1-y home time, which was defined as the number of days spent outside of a nursing home after stroke [ 52 ]; and 90 or 100 d of NHA after a traumatic brain injury experience [ 30 , 31 ]). Further, 1 study [ 39 ] used a distinctive outcome measure to define NHA, which was “whether the subject was recommended by healthcare experts to live in residential care.”…”

Machine Learning-Based Prognostic Models for Long-Term Care in Traumatic Brain Injury Patients Unable to Return Home: A Retrospective Analysis of ICU Admissions

“…Our demographic analysis reveals that 11.68% (236/2020) of TBI patients did not return home upon discharge, a notably lower percentage than reported in previous studies (20% to 38% ICU survivors) (26). This difference may stem from variations in patient severity; our study focused on a broader GCS range (mean 12.27 ± 4.11) compared to previous studies concentrating on moderate to severe cases (GCS [3][4][5][6][7][8][9][10][11][12].…”

“…Several studies have identi ed a range of predictive factors that may signi cantly in uence the outcomes of individuals with TBI in both acute and chronic stages. These factors include age (8, 9), sex (9,10), obesity (11), Glasgow Coma Scale (GCS), and pupil reactivity (12,13), computed tomography (CT) ndings (14,15), surgery (8, 16), injury severity (17)(18)(19)(20), vasopressor use (21), endotracheal tube intubation (22), intracranial pressure monitoring use (23), and hypnotic-sedative drug use (24). Therefore, establishing how to effectively utilize these feature variables for predicting outcomes is a crucial issue.…”

Current situation and factors influencing elderly care in community day care centers: a cross-sectional study

“…Compared with pure elderly care institutions, it has the advantages of low fees, less investment, convenient proximity, free access, moderate space, and more complete services ( 13 ). It can maintain functional needs to a certain extent, meet psychological needs, increase social interaction, and reduce the burden on caregivers ( 14 , 15 ). Therefore, the construction of community day care centers is a realistic choice to solve the problems of elderly care in our country.…”