Research Reports - Comorbidity and insurance as predictors of disability following traumatic brain injury
Arch Phys Med Rehabil. 2014 Jun 24
Gardizi E(1), Hanks RA(2), Millis SR(2), Figueroa MJ(3)
OBJECTIVE: To examine the unique contribution of self-reported medical
comorbidity and insurance type on disability following traumatic brain injury
DESIGN: Inception cohort design at one-year follow up. Setting: The
Rehabilitation Institute of Michigan (RIM). Participants: Seventy-adults with
mild-complicated to severe TBI.
MAIN OUTCOME MEASURES: Self-reported medical comorbidities were measured using
the Modified Cumulative Illness Rating Scale (MCIRS) while insurance type was
classified as commercial or government-funded; disability was measured using the
Disability Rating Scale (DRS).
RESULTS: Two models were run using multiple linear regression and the best
fitting model was selected based on the Bayesian Information Criterion (BIC). The
full model which included self-reported medical comorbidity and insurance type
was significantly better fitting than the reduced model. Participants with longer
duration of posttraumatic amnesia, more self-reported medical comorbidities, and
government insurance were more likely to have higher levels of disability.
Meanwhile, individual organ systems were not predictive of disability.
CONCLUSIONS: The cumulative impact of self-reported medical comorbidities and
type of insurance coverage predict disability above and beyond well-known
prognostic variables. Early assessment of medical complications and improving
services provided by government-funded insurance may enhance quality of life and
reduce long-term health care costs.