Disclosures: Michael Chiou, MD: No financial relationships or conflicts of interest

Objective: To describe changes in acute inpatient rehabilitation length of stay (LOS) for patients with traumatic brain injury (TBI), describe predictors of LOS, and explore first-year anniversary medical and social outcomes

Design: Longitudinal, exploratory study of patients with TBI Setting : Sixteen Traumatic Brain Injury Model System Centers across the United States Participants : A total of 7,079 patients enrolled in the Model Systems between 2010 and 2017

Interventions: Not applicable

Main Outcome Measures: Rehabilitation LOS; incidence of rehospitalization within one year of discharge from a Traumatic Brain Injury Model System center; community or institutional residence post-discharge and at first-year anniversary

Results: Acute rehabilitation LOS declined from 27 days to 23 days. Discharges to skilled nursing facilities and rehospitalizations increased between 2010 and 2017. Logistic regression showed that lower admission Functional Independence Measure (FIM) scores, higher Disability Rating Scale scores, lower Glasgow Coma Scale scores, and longer length of acute hospitalization were related to longer LOS. Race, education, and discharge disposition were also related to LOS. At first-year anniversary, linear regression revealed that discharge FIM scores, discharge to institution, and age were related to rehospitalization. Conclusions: Higher functional status is associated with shorter acute inpatient rehabilitation LOS and discharge to the community. LOS is often viewed as an indicator of health care delivery efficiency. It is a function of multiple complex and interacting factors, from medical acuity and social situation to insurance type and reimbursement pattern. It is not known how short LOS can be for patients with TBI before negative outcomes increase, resulting in less efficiency and higher cost. It is concerning that acute inpatient rehabilitation LOS for patients with TBI declined by 15% from 2010 to 2017. In this study, 17.6% of patients were discharged to a skilled nursing facility and 27.8% of patients were rehospitalized within one year of discharge from acute inpatient rehabilitation at a Model System center.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-inpatient-rehabilitation-length-of-stay-and-outcomes-for-patients-enrolled-in-the-traumatic-brain-injury-model-systems-2010-2017/