TY - JOUR
T1 - Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes
AU - Dahdah, Marie N.
AU - Barnes, Sunni
AU - Buros, Amy
AU - Dubiel, Rosemary
AU - Dunklin, Cynthia
AU - Callender, Librada
AU - Harper, Caryn
AU - Wilson, Amy
AU - Diaz-Arrastia, Ramon
AU - Bergquist, Thomas
AU - Sherer, Mark
AU - Whiteneck, Gale
AU - Pretz, Christopher
AU - Vanderploeg, Rodney D.
AU - Shafi, Shahid
N1 - Publisher Copyright:
© 2016 American Congress of Rehabilitation Medicine
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objective To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. Design Multicenter observational cohort study. Setting TBIMS centers. Participants Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003–2012 (N=5505). Interventions Not applicable. Main Outcome Measures Functional outcomes of patients with TBI. Results Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. Conclusions Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.
AB - Objective To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. Design Multicenter observational cohort study. Setting TBIMS centers. Participants Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003–2012 (N=5505). Interventions Not applicable. Main Outcome Measures Functional outcomes of patients with TBI. Results Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. Conclusions Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.
KW - Brain injuries
KW - Inpatients
KW - Rehabilitation
KW - Treatment outcome
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U2 - 10.1016/j.apmr.2016.05.005
DO - 10.1016/j.apmr.2016.05.005
M3 - Article
C2 - 27246623
AN - SCOPUS:84992650920
SN - 0003-9993
VL - 97
SP - 1821
EP - 1831
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 11
ER -