Identifying factors associated with acute hospital discharge dispositions in patients with moderate-to-severe traumatic brain injury

ABSTRACT

Objective

Identify sociodemographic, injury, and hospital-level factors associated with acute hospital discharge dispositions following acute hospitalization for moderate-to-severe traumatic brain injury (TBI) in the United States.

Methods

The 2011–2014 National Trauma Data Bank data was used, including 466 acute care hospitals and 114,736 patients ≥16 years old who survived moderate-to-severe TBI. Outcome was acute hospital discharge dispositions: home with/without care (HC), skilled nursing home/other care facility (SNF/ICF) and inpatient rehabilitation/long-term care facility (IRF). Independent variables were patients’ sociodemographic, injury, and hospital-level factors. Multilevel modeling was used to assess associations and compare likelihood of discharges.

Results

Of all patients, 74.5%, 14.6% ,and 10.9% were discharged to HC, SNF/ICF ,and IRF, respectively. Intraclass correlation coefficients indicated that hospitals explained 14.3% and 14.8% of variations in probabilities of institution dispositions. Sociodemographic factors including older age, females, Non-Hispanic Whites, recipients of commercial insurance, and Medicare/Medicaid were significantly associated with higher institution discharges. Hospital-related factors including bed size, teaching status, trauma accreditations, and hospital locations were significantly associated with discharge dispositions.

Conclusion

Identifying factors associated with discharge dispositions after acute hospitalization of TBI is pertinent to ensure quality of care and optimal patient outcomes. Further research into hospital-related variations in acute care discharge dispositions is recommended.

KEYWORDS:

• Traumatic brain injury
• rehabilitation
• acute care discharge
• National Trauma Data Bank
• discharge disposition

Acknowledgments

The authors wish to acknowledge Whitney Graves for her assistance with data processing and extraction.

Disclosure statement

No potential conflict of interest was reported by the author(s). Any findings, conclusions, or recommendations expressed in this publication reflect those of the author(s) and do not necessarily reflect the view of Virginia Commonwealth University.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

This work was supported by the Virginia Commonwealth University’s School of Medicine Center for Rehabilitation Science and Engineering.