Longitudinal Investigation of Rehospitalization Patterns in Spinal Cord Injury and Traumatic Brain Injury Among Medicare Beneficiaries. 2017

Christopher R Pretz, and James E Graham, and Addie Middleton, and Amol M Karmarkar, and Kenneth J Ottenbacher
Research Department, Craig Hospital, Englewood, CO.

To model 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for spinal cord injury (SCI) or traumatic brain injury (TBI) and to create 2 (SCI- and TBI-specific) interactive tools enabling users to generate monthly projected probabilities of rehospitalization on the basis of an individual patient's clinical profile at discharge from inpatient rehabilitation. Secondary data analysis. Inpatient rehabilitation facilities. Medicare beneficiaries receiving inpatient rehabilitation for SCI (n=2587) or TBI (n=10,864). Not applicable. Monthly rehospitalization (yes/no) based on Medicare claims. Results are summarized through computer-generated interactive tools, which plot individual level trajectories of rehospitalization probabilities over time. Factors associated with the probability of rehospitalization over time are also provided, with different combinations of these factors generating different individual level trajectories. Four case studies are presented to demonstrate the variability in individual risk trajectories. Monthly rehospitalization probabilities for the individual high-risk TBI and SCI cases declined from 33% to 15% and from 41% to 18%, respectively, over time, whereas the probabilities for the individual low-risk cases were much lower and stable over time: 5% to 2% and 6% to 2%, respectively. Rehospitalization is an undesirable and multifaceted health outcome. Classifying patients into meaningful risk strata at different stages of their recovery is a positive step forward in anticipating and managing their unique health care needs over time.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010351 Patient Discharge The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities. Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D010359 Patient Readmission Subsequent admissions of a patient to a hospital or other health care institution for treatment. Hospital Readmission,Rehospitalization,Unplanned Hospital Readmissions,Unplanned Readmission,30 Day Readmission,Hospital Readmissions,Readmission, Hospital,Readmissions, Hospital,Thirty Day Readmission,30 Day Readmissions,Hospital Readmission, Unplanned,Hospital Readmissions, Unplanned,Readmission, Patient,Readmission, Thirty Day,Readmission, Unplanned,Rehospitalizations,Thirty Day Readmissions,Unplanned Hospital Readmission,Unplanned Readmissions
D004185 Disability Evaluation Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits. Disability Evaluations,Evaluation, Disability,Evaluations, Disability
D005260 Female Females
D006278 Medicare Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976) Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070642 Brain Injuries, Traumatic A form of acquired brain injury which occurs when a sudden trauma causes damage to the brain. Trauma, Brain,Traumatic Brain Injury,Encephalopathy, Traumatic,Injury, Brain, Traumatic,TBI (Traumatic Brain Injury),TBIs (Traumatic Brain Injuries),Traumatic Encephalopathy,Brain Injury, Traumatic,Brain Trauma,Brain Traumas,Encephalopathies, Traumatic,TBI (Traumatic Brain Injuries),Traumas, Brain,Traumatic Brain Injuries,Traumatic Encephalopathies
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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