Research Reports - Racial/ethnic and insurance status disparities in discharge to posthospitalization care for patients with traumatic brain injury
J Head Trauma Rehabil. 2014 Feb 28
Kane WG(1), Wright DA, Fu R, Carlson KF
OBJECTIVES:: Professional, posthospitalization care (PHC) can improve outcomes
among patients with traumatic brain injury. We examined disparities in discharge
to PHC by patients' race/ethnicity and insurance type.
PARTICIPANTS:: A total of 6061 adults hospitalized for unintentional traumatic
brain injury in Oregon, 2008 to 2011.
MAIN OUTCOME MEASURE:: Posthospitalization care was assessed on the basis of
discharge disposition. Multivariable logistic regression was used to estimate
effects of race/ethnicity and insurance on referral to PHC while controlling for
potential confounders. Generalized estimating equations were used to calculate
odds ratios (ORs) and 95% confidence intervals (CIs), accounting for clustering
of data by hospital.
RESULTS:: 28% of patients were discharged to PHC. While controlling for potential
confounders, Hispanics were less likely to be discharged to PHC (OR, 0.62; CI,
0.40-0.96) than non-Hispanic whites. Compared with patients with private
insurance, uninsured patients were less likely to be discharged to PHC (OR, 0.19;
CI, 0.11-0.32) whereas patients with public insurance (OR, 1.65; CI, 1.33-2.05)
and worker's compensation (OR, 1.66; CI, 1.09-2.52) were more likely to be
discharged to PHC.
CONCLUSIONS:: Results suggest that racial/ethnic and insurance disparities exist
in discharge to postacute care after hospitalization for traumatic brain injury.
Future research should examine factors that might contribute to and reduce these
inequities in care.