Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Asemota, Anthony O.; George, Benjamin P.; Cumpsty-Fowler, Carolyn; Haider, Adil H.; Schneider, Eric B.

doi:10.1089/neu.2013.3091

Cited by 130 publications

(109 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,4 Patterns in availability of pediatric outpatient rehabilitation for Spanish speakers and others with LEP are particularly challenging. Other studies have documented that non-English speaking status adversely affects access to care for Latinos in the United States 20 and that, for children, parental LEP results in greater odds of children not receiving needed medical care.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies, mainly in adult populations, have described important racial and ethnic disparities in access to acute and inpatient rehabilitation services. 2,3,4,5 One pediatric study described higher unmet health care needs after TBI for non-white children and those with Medicaid insurance. 6 In addition, studies documenting outcomes after TBI have found that Hispanic and Spanish-speaking adults with TBI have poorer functional outcomes compared to non-Hispanic Whites (NHW).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

Moore

Jimenez

Rowhani-Rahbar

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

View full text Add to dashboard Cite

Objective To explore associations between English proficiency, insurance status, outpatient rehabilitation service availability and travel time for children with traumatic brain injury (TBI). Design We used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children with moderate to severe TBI and rehabilitation providers in Washington State. Main measures included availability and travel time to services. Results Fewer than 20% of providers accepted children with Medicaid and provided language interpretation. Mental health services were most limited. Adjusted for median household income, multilingual service availability was lowest in counties with greater language diversity; for every 10% increase in persons >5 years old speaking a language other than English at home, there was a 34% decrease in availability of multilingual services (PR=0.66; 95%; CI:0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families had significantly longer travel times to services (mean=16 additional minutes to mental health; 9 to other therapies). Conclusions Children in households with limited English proficiency and Medicaid faced significant barriers in availability and proximity of outpatient rehabilitation services. Innovative service strategies are needed to equitably improve availability of rehabilitation for children with TBI. Similar studies in other regions will inform our understanding of the scope of these disparities.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

Moore

Jimenez

Rowhani-Rahbar

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

View full text Add to dashboard Cite

show abstract

“…Analogously, Asemota et al reported that, among patients with traumatic brain injury, Hispanics and blacks were less likely to be discharged to supportive care compared to whites. 22 In the realm of orthopaedic trauma, a recent study by Nguyen-Oghalai et al found that racial minorities were more likely to be discharged home to self-care after hip fracture. 11 The reasons for the lower utilization of supportive services among historically disadvantaged populations remain largely unexplored and warrant further study.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is consistent with previous studies reporting restricted access to supportive services for uninsured patients after traumatic brain injury and aneurysmal subarachnoid haemorrhage. 22,35 The disproportionate allocation of supportive services to insured patients might place uninsured individuals at higher risk of permanent disability. 36 On the other hand, it is possible that more care does not increase health and this issue needs to be studied for each specific condition.…”

Section: Discussionmentioning

confidence: 99%

Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture

Menendez

Ring

2014

Shoulder & Elbow

View full text Add to dashboard Cite

Background: Post-discharge supportive services such as home health assistance and rehabilitation or skilled nursing facilities are often utilized after inpatient care for fracture of the proximal humerus. It is unclear whether sociodemographic disparities exist in the utilization of post-hospital supportive care. The present study aimed to evaluate the individual and combined effects of race and insurance status on the utilization of supportive services after hospital admission for fracture of the proximal humerus. Methods: Among the more than 40,000 patients with a proximal humerus fracture identified in the Nationwide Inpatient Sample (2008 to 2011), 85% were white, 7.7% were Hispanic and 7.0% were black. More black patients (19%) and Hispanic patients (15%) were uninsured compared to white patients (8.7%). Multivariable logistic regression was performed to determine the effect of race/ethnicity and insurance status on the utilization of post-hospital supportive care. Results: Sixty-nine percent of patients were discharged home, 13% went to home health care and 15% went to rehabilitation or skilled nursing facilities. Compared to white patients, Hispanic patients [odds ratio (OR) ¼ 0.71; 95% confidence interval (CI) ¼ 0.64 to 0.79] and black patients (OR ¼ 0.79; 95% CI ¼ 0.71 to 0.88) exhibited lower odds for the utilization of specialized post-hospital supportive services. Uninsured patients were significantly less likely to use post-discharge supportive services (OR ¼ 0.38; 95% CI ¼ 0.33 to 0.42) compared to privately insured patients. Even when insured at levels comparable to whites, Hispanic and black patients tended to experience decreased rates of discharge to post-acute supportive care. Conclusions: The utilization of post-hospital supportive services varies by race, ethnicity and insurance status after an inpatient admission for proximal humerus fracture.

show abstract

“…A study conducted by Asemota et al showed that, compared with insured white patients, insured African American patients were less likely to be discharged to rehabilitation centers. 2 Furthermore, Bowman et al observed a decreased proportion of Hispanic and African American patients discharged to a rehabilitation center after TBI compared with Caucasians. 3 Additionally, studies have revealed racial/ethnic differences in follow-up after discharge.…”

Section: Discussionmentioning

confidence: 99%

Gunshot wounds to the head: racial disparities in inpatient management and outcomes

Chiu¹,

Fuentes²,

Mehta³

2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVESeveral studies have indicated that racial disparities may exist in the management and outcomes of acute trauma care. One segment of trauma care that has not been as extensively investigated, however, is that of cranial trauma care. The goal of this study was to determine whether significant differences exist among racial and ethnic groups in various measures of inpatient management and outcomes after gunshot wounds to the head (GWH).METHODSIn this study, the authors used the Nationwide (National) Inpatient Sample (NIS) to investigate all-cause mortality, receipt of surgery, days from admission to initial intervention, discharge disposition, length of hospital stay, and total hospital charges of those with GWH from 2012 to 2016. A 1:1 propensity score–matched analysis was conducted to evaluate the effect of race on these endpoints, while controlling for baseline demographics and comorbidities.RESULTSA total of 333 patients met the inclusion and exclusion criteria: 148 (44.44%) white/Caucasian, 123 (36.94%) black/African American, 54 (16.22%) Hispanic/Latinx, and 8 (2.40%) Asian. African American patients were sent to immediate care and rehabilitation significantly less often than Caucasian patients (RR 0.17 [95% CI 0.04–0.71]). There were no significant differences in mortality, length of stay, rates of surgical intervention, or total hospital charges among any of the racial groups.CONCLUSIONSThe authors’ findings suggest that racial disparities in inpatient cranial trauma care and outcomes may not be as prevalent as previously thought. In fact, the disparities seen were only in disposition. More research is needed to further elucidate and address disparities within this population, particularly those that may exist prior to, and after, hospitalization.

show abstract

Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Cited by 130 publications

References 47 publications

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

Racial and insurance disparities in the utilization of supportive care after inpatient admission for proximal humerus fracture

Gunshot wounds to the head: racial disparities in inpatient management and outcomes

Contact Info

Product

Resources

About