Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems (TBIMS) Study and the Influence of Demographics and Injury Severity on Patient Outcomes

Publication date: Available online 28 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Marie N. Dahdah, Sunni Barnes, Buros Amy, Rosemary Dubiel, Cynthia Dunklin, Librada Callender, Caryn Harper, Amy Wilson, Ramon Diaz-Arrastia, Thomas Bergquist, Mark Sherer, Gale Whiteneck, Christopher Pretz, Rodney D. Vanderploeg, Shahid Shafi
ObjectiveTo compare patient functional outcomes across TBIMS rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes.SettingTraumatic Brain Injury Model Systems (TBIMS) Centers.ParticipantsTBI patients admitted to 19 TBIMS rehabilitation centers from 2003 to 2012 (Total N = 5,505).DesignMulticenter observational cohort study.Main Outcome MeasuresFunctional outcomes of patients with TBI.ResultsIndividuals with lower functional status at the time of admission, longer duration of post-traumatic amnesia (PTA), and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at 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 upon the regression models by adding predictors known to influence functional outcomes, and employing bootstrapping to eliminate confounds.ConclusionsSpecific 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.



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