Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury

Abstract

Background/Objectives Rates of traumatic brain injury (TBI) among older adults and treatment of this population in nursing homes are increasing. The objective of this study is to examine differences in the quality of care and outcomes of older adults with TBI in rural and urban settings by (1) comparing the rates of successful community discharge; and (2) reasons for not achieving successful discharge among patients in rural and urban environments. Design Retrospective national cohort study of skilled nursing facility (SNF) patients using Medicare inpatient claims linked with Minimum Data Set assessments. Demographic, health, and facility characteristics were compared between rural and urban settings using descriptive statistics. Logistic regression with state random effects was used to identify characteristics that predicted successful discharge. Setting U.S. skilled nursing facilities (n = 11,771). Participants Medicare beneficiaries aged 66 and older discharged to a SNF following hospitalization for TBI between 2011 and 2015 (n = 61,021). Measurements Successful community discharge defined as discharge from SNF within 100 days of admission and remaining in the community for ≥30 days without dying or admission to an inpatient healthcare facility. Results Unadjusted rates of successful discharge were significantly lower for patients in rural settings compared with patients in urban settings (52.1% vs 58.5%, p < 0.01). Patients in rural settings had lower adjusted odds (odds ratio 0.84, 95% confidence interval = 0.80–0.89) of successful discharge. Reasons for not discharging successfully differed between rural and urban settings with rural patients less likely to discharge from SNF within 100 days though also less likely to be rehospitalized within 30 days of SNF discharge. Conclusion Given the low overall rate of successful community discharge and worse outcomes among rural patients, further research to explore interventions to improve SNF care and discharge planning in this population is warranted.

A Scoping Literature Review of Rural Institutional Elder Care

“…Regarding the status quo of discharge from aged care institutions, the emergency transfer rate of rural nursing institutions is lower than that of urban nursing institutions due to their limited traffic and medical diagnosis level [ 28 , 70 ]. Even worse, the overall success rate of community discharge of rural elderly is considerably lower than that of urban elderly [ 71 ].…”

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

“…The RISS is calculated based on ICD-9-CM and ICD-10-CM injury diagnosis codes and R statistical software (ICDPIC-R). 28 RISS scores can be interpreted as mild (<9), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), and profound (≥25). 29 Initial discharge destination was categorized as community, SNF, IRF, or other.…”

“…[10][11][12] Older patients with TBI who are socioeconomically disadvantaged, have functional impairments, or live in rural areas are less likely to return to the community following the acute hospitalization and subsequent SNF care. 13,14 Older adults with TBI are more likely to be readmitted following acute care hospitalization, 15,16 especially those transferred to IRFs 17,18 or SNFs. 13,17 Although they experience slower functional gains over shorter lengths of stay than younger adults, 3,19 older adults with TBI benefit from receiving rehabilitation and care supporting their return to home.…”

“…In the United States, older adults with TBI are more likely than younger patients to be transferred to a post‐acute care facility following the initial hospitalization 10–12 . Older patients with TBI who are socioeconomically disadvantaged, have functional impairments, or live in rural areas are less likely to return to the community following the acute hospitalization and subsequent SNF care 13,14 . Older adults with TBI are more likely to be readmitted following acute care hospitalization, 15,16 especially those transferred to IRFs 17,18 or SNFs 13,17 .…”

Reducing risks in complex care transitions in rural areas: a grounded theory

“…The risk of readmissions is higher when discharged to home healthcare in an ordinary residence than to a skilled nursing facility (Werner et al, 2019 ). Successful discharges and the risk of readmissions within 30 days of discharge differ between urban and rural residents (Anderson et al, 2021 ).…”