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

Christopher R. Pretz, James E. Graham, Addie Middleton, Amol M. Karmarkar, Kenneth J. Ottenbacher

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objectives To model 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for spinal cord injury (SCI) or traumatic brain injury (TBI) and to create 2 (SCI- and TBI-specific) interactive tools enabling users to generate monthly projected probabilities of rehospitalization on the basis of an individual patient's clinical profile at discharge from inpatient rehabilitation. Design Secondary data analysis. Setting Inpatient rehabilitation facilities. Participants Medicare beneficiaries receiving inpatient rehabilitation for SCI (n=2587) or TBI (n=10,864). Interventions Not applicable. Main Outcome Measures Monthly rehospitalization (yes/no) based on Medicare claims. Results Results are summarized through computer-generated interactive tools, which plot individual level trajectories of rehospitalization probabilities over time. Factors associated with the probability of rehospitalization over time are also provided, with different combinations of these factors generating different individual level trajectories. Four case studies are presented to demonstrate the variability in individual risk trajectories. Monthly rehospitalization probabilities for the individual high-risk TBI and SCI cases declined from 33% to 15% and from 41% to 18%, respectively, over time, whereas the probabilities for the individual low-risk cases were much lower and stable over time: 5% to 2% and 6% to 2%, respectively. Conclusions Rehospitalization is an undesirable and multifaceted health outcome. Classifying patients into meaningful risk strata at different stages of their recovery is a positive step forward in anticipating and managing their unique health care needs over time.

Original languageEnglish (US)
Pages (from-to)997-1003
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number5
DOIs
StatePublished - May 2017

Keywords

  • Brain injuries, traumatic
  • Longitudinal studies
  • Patient readmission
  • Rehabilitation
  • Spinal cord injuries

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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