Investigating Disparities in Acute Rehabilitation Outcomes Among Individuals With TBI and SCI: A Retrospective Chart Review of UDS Data.
Elizabeth C Pasipanodya, Benjamin Dirlikov, Tene A Cage and 1 others
PMID 42769699WHAT IT FOUND
Insurance type predicted acute rehab outcomes for TBI and SCI patients.
Publicly insured had lower discharge function than commercially insured, despite similar length of stay. Workers' compensation patients stayed longer and had higher discharge function. No differences were found for race or sex.
Key findings
01Publicly insured individuals had significantly lower discharge FIM scores than those with commercial insurance, even after controlling for injury severity and other factors.
02Individuals with workers' compensation had a longer length of stay than those with commercial insurance and were more likely to be discharged to an acute care setting.
03Rehabilitation outcomes did not differ significantly by sex or race/ethnicity in this sample.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Community SES was estimated using zip code median income, which may not accurately reflect individual-level socioeconomic status. The study excluded patients with major multiple trauma or nontraumatic injuries, potentially limiting generalizability to complex rehabilitation cases. The data came from a single safety-net hospital in a state with high Medicaid utilization, which may identify fewer payor-based disparities than studies in other settings. The retrospective nature of the study prevented analysis of specific service authorizations or concurrent reviews that might explain outcome differences. The study concluded in 2020 due to the discontinuation of FIM data collection, so findings may not reflect current outcome measures like the COS.
Declared interests
The investigators have no financial or nonfinancial disclosures to make in relation to this project.
The easy way to misread this
Do not interpret the lack of significant racial or sex-based disparities in this study as evidence that such disparities do not exist in rehabilitation. The sample was drawn from a single safety-net hospital with high Medicaid utilization, which may mask differences seen in other settings, and the measure of community SES was a proxy for individual socioeconomic status.