Healthy Days at Home Among Older Medicare Beneficiaries With Traumatic Brain Injury Requiring Inpatient Rehabilitation.

This was a retrospective descriptive and correlational study, so it cannot show that any treatment or service caused more days at home. The sample included only adults aged 66 or older who required inpatient rehabilitation and survived to discharge, so it does not represent younger people, people with TBI who did not need inpatient rehabilitation, or people who died before discharge. It included only community-dwelling adults at the time of TBI, so it does not represent older adults who were already living in institutions. The data were fee-for-service Medicare records from 2012 to 2014, so results may not apply to Medicare Advantage beneficiaries, who now represent roughly half of all Medicare beneficiaries, or to current care patterns. Linking Medicare data with the trauma registry reduced the sample size; the mean sample size was 631, and it varied from 220 to 892 across replicate linked samples. Observation days and outpatient emergency department days were not counted because complete outpatient claims were unavailable. Healthy Days at Home after discharge subtracted death days, so lower healthy days can reflect dying sooner as well as more care use. Sensitivity analyses among survivors only changed some findings, including making the mobility association borderline and showing a significant association with dual Medicaid status.

The authors reported no conflicts of interest. The supplied publication types indicate NIH extramural research support, but the article does not state whether the funder designed or wrote the study.

Do not conclude that improving mobility will increase days at home. This was an observational study of administrative records, not a treatment trial, and it did not establish cause.