Longitudinal Investigation of Rehospitalization Patterns in Spinal Cord and Traumatic Brain Injury among Medicare Beneficiaries

Arch Phys Med Rehabil, 2017 · DOI: 10.1016/j.apmr.2016.12.012 · Published: May 1, 2017

Spinal Cord Injury Rehabilitation Brain Injury

Simple Explanation

The study examines rehospitalization risk among Medicare beneficiaries who underwent inpatient rehabilitation for spinal cord injury (SCI) or traumatic brain injury (TBI). The goal was to create interactive tools to predict individual rehospitalization probabilities based on clinical profiles at discharge. The study used Medicare data to track rehospitalizations within 12 months after discharge from inpatient rehabilitation facilities. They analyzed factors like demographics, clinical variables, and functional status to model the probability of rehospitalization. The interactive tools generated from this study allow clinicians to input patient-specific data and visualize the projected probability of rehospitalization over time. This can help tailor care plans and resource allocation to manage individual healthcare needs.

Study Duration

12 Months

Participants

Medicare beneficiaries receiving inpatient rehabilitation for SCI or TBI

Evidence Level

Secondary data analysis

Key Findings

1
The study found that rehospitalization risk decreases over time in both SCI and TBI patients.
2
Factors such as tier comorbidity, prior acute stays, IRF length of stay, and discharge functional status were significant contributors to readmission risk in both SCI and TBI populations.
3
Sociodemographic variables like age, sex, race/ethnicity, and disability benefits were significant contributors to the TBI model, but not the SCI model.

Research Summary

This study modeled 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for SCI or TBI. The ultimate goal was to use the longitudinal Medicare data to create two interactive tools enabling users to generate monthly projected probabilities for rehospitalization. The study identified several clinically-relevant variables were independent contributors to readmission risk in both populations: tier comorbidity, prior acute stays, IRF length of stay, and discharge functional status, with the latter three also demonstrating time-moderated effects. The risk trajectories generated from the interactive tools attached to this report enable users to obtain visual estimates of an individual’s monthly projected probabilities for rehospitalization over the year following discharge from inpatient rehabilitation.

Practical Implications

Risk Stratification

Classifying patients into meaningful risk strata can help clinicians anticipate and manage their unique healthcare needs.

Transitional Care Planning

Stratifying patient risks at discharge may inform transitional care plans and targeting of resources for selective follow-up services.

Improved Patient Outcomes

Targeting of resources for selective follow-up services could lead to better patient outcomes and experiences as well as better provider quality performance ratings.

Study Limitations

1
The assumptions for and relationships from this study were limited to Medicare fee-for-service beneficiaries who received inpatient rehabilitation following acute hospitalization for SCI or TBI.
2
Other factors potentially related to rehospitalization were not available in the claims data (e.g., TBI severity) and thus, were not included in our models.
3
The analysis involves a “double estimation” process... Such an estimation process introduces additional error; although, error remains relatively small due to the large study sample.

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