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

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• 作者：Marie N. Dahdah ; PhD^a ; ^b ; ^c ; Sunni Barnes ; PhD^d ; Amy Buros ; MS^d ; Rosemary Dubiel ; DO^a ; ^b ; Cynthia Dunklin ; BS ; CCRC^b ; Librada Callender ; BS ; CCRC^b ; Caryn Harper ; BS^b ; Amy Wilson ; MD^a ; Ramon Diaz-Arrastia ; MD ; PhD^b ; ^e ; ^f ; Thomas Bergquist ; PhD ; ABPP^g ; Mark Sherer ; PhD ; ABPP^h ; Gale Whiteneck ; PhDⁱ ; Christopher Pretz ; PhD^j ; Rodney D. Vanderploeg ; PhD ; ABPP^k ; Shahid Shafi ; MD ; MPH ; FACS^b ; ^d ; ^{shahid.shafi@baylorhealth.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Brain injuries ; Inpatients ; Rehabilitation ; Treatment outcome
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：97
• 期：11
• 页码：1821-1831
• 全文大小：457 K

文摘

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.