The Association Between Payer Source and Traumatic Brain Injury Rehabilitation Outcomes: A TBI Model Systems Study.

The analysis excluded adults aged 65 and older, so it does not speak to Medicare beneficiaries or older adults with TBI. Of 9,641 individuals under age 64 in the database, 8,558 were analyzed after missing key variables, so people with incomplete records were not included. The sample included only people who received inpatient rehabilitation at TBIMS centers, so it does not cover people with moderate to severe TBI who did not receive that care. Payer source was recorded at enrollment and may have changed during hospitalization, and public insurance combines Medicare, Medicaid, dual eligible, and Medicare Advantage programs. Neighborhood income was based on zip code rather than more precise address, which may make the socioeconomic adjustment less exact. A small percentage (2%) were discharged to acute care and did not return to rehabilitation within 30 days, and it is unclear whether they completed rehabilitation. Racial and ethnic minority groups were combined because some categories had too few people for separate conclusions. The study reports associations between payer source and outcomes; it does not show that insurance caused shorter stays or lower discharge independence.

Do not conclude that insurance status directly caused better or worse recovery. The paper reports associations, and the discharge independence difference among payer groups was no longer seen after length of stay was included.