Disclosures: Alissa A. Totman, MD, MPH: No financial relationships or conflicts of interest

Objective: Describe trends among the most severely-impaired patients following a traumatic brain injury (TBI) admitted to inpatient medical rehabilitation facilities

Design: Retrospective case series Setting : Inpatient rehabilitation facilities Participants : Patients admitted to an IRF that reports to the Uniform Data System for Medical Rehabilitation® (UDSMR®) with a primary diagnosis of “brain dysfunction” (open or closed head injury) and admission FIM® of 18

Interventions: Not applicable

Main Outcome Measures: Number of discharges, age, length of stay, discharge disposition, discharge FIM®, payer source

Results: 10,098 patients were included in the study. From 2002 to 2017, the number of severely-impaired patients discharged from medical rehabilitation facilities decreased (649 to 488), and the percent discharged to the community increased (46.4% to 77.3%). During the study period, the mean age increased (43.0 to 53.7 years) and the length of stay decreased (41.5 to 29.3 days), while the mean discharge FIM® decreased slightly (47.2 to 43.4). There was an increase in the proportion of Medicare patients (21.3 to 43.2%), a decrease in commercially-insured patients (42.7 to 24.8%), and a decrease in patients with other reimbursement sources (6.5 to 3.2%) over the course of the study. Conclusions: Over time, the number of severely-impaired traumatic brain injury patients admitted to medical rehabilitation facilities, including patients with disorders of consciousness (DOC), is decreasing. This may have widespread implications, including difficulty maintaining adequate enrollment numbers for clinical trials involving DOC, and may limit adequate exposure to such populations for brain injury trainees. This decrease may represent a combination of primary prevention, early ICU mortality, alternative discharge dispositions, or changes in insurance practices that do not appreciate the long term potential outcome of such individuals. Increasing proportions of home discharges may reflect changes in reimbursement structures, which may place increased burden on home care agencies. The implications of these changes on long-term patient outcomes are not clear and require further investigation.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/changes-in-the-severely-injured-rehabilitation-patient-population-following-traumatic-brain-injury/