TY - JOUR
T1 - Discharge disposition from acute care after traumatic brain injury
T2 - The effect of insurance type
AU - Chan, Leighton
AU - Doctor, Jason
AU - Temkin, Nancy
AU - MacLehose, Richard F.
AU - Esselman, Peter
AU - Bell, Kathleen
AU - Dikmen, Sureyya
N1 - Funding Information:
Supported by the National Institute on Disability and Rehabilitation Research through the Traumatic Brain Injury Model Systems Project (grant no. H133A980023). The views expressed here are those of the authors and not necessarily of the University of Washington of the Health Care Financing Administration.
PY - 2001
Y1 - 2001
N2 - Objective: To determine if persons with traumatic brain injury (TBI) who are insured by Medicaid or health maintenance organizations (HMOs) are more likely to receive postacute care in skilled nursing facilities (SNFs) than in rehabilitation facilities, compared with persons insured by commercial fee-for-service (FFS) plans. Design: Retrospective cohort study. Setting: County hospital admitting 30% of all Washington State TBI patients. Patients: Patients with moderate to severe TBI discharged to rehabilitation facilities or SNFs between 1992 and 1997 (n = 1271); 56.3% were insured by Medicaid, 26.1% by FFS plans, and 17.6% by HMOs. Interventions: Not applicable. Main Outcome Measures: Disposition on discharge from acute care (rehabilitation facilities vs SNF); adjusted relative risk (RR) and confidence interval (CI) for different insurance types. Results: After accounting for confounding factors, Medicaid patients were 68% more likely (RR = 1.68, 95% CI = 1.34-2.11) and HMO patients were 23% more likely (RR = 1.23, 95% CI =.90-1.68) to go to a SNF than FFS patients. However, the latter difference was not statistically significant. Conclusions: An association exists between insurance type and postacute care site. Efforts should be made to determine the effect this relationship has on the cost and outcomes for TBI patients.
AB - Objective: To determine if persons with traumatic brain injury (TBI) who are insured by Medicaid or health maintenance organizations (HMOs) are more likely to receive postacute care in skilled nursing facilities (SNFs) than in rehabilitation facilities, compared with persons insured by commercial fee-for-service (FFS) plans. Design: Retrospective cohort study. Setting: County hospital admitting 30% of all Washington State TBI patients. Patients: Patients with moderate to severe TBI discharged to rehabilitation facilities or SNFs between 1992 and 1997 (n = 1271); 56.3% were insured by Medicaid, 26.1% by FFS plans, and 17.6% by HMOs. Interventions: Not applicable. Main Outcome Measures: Disposition on discharge from acute care (rehabilitation facilities vs SNF); adjusted relative risk (RR) and confidence interval (CI) for different insurance types. Results: After accounting for confounding factors, Medicaid patients were 68% more likely (RR = 1.68, 95% CI = 1.34-2.11) and HMO patients were 23% more likely (RR = 1.23, 95% CI =.90-1.68) to go to a SNF than FFS patients. However, the latter difference was not statistically significant. Conclusions: An association exists between insurance type and postacute care site. Efforts should be made to determine the effect this relationship has on the cost and outcomes for TBI patients.
KW - Brain injuries
KW - Health care economics and organizations
KW - Health maintenance organizations
KW - Medicaid
KW - Patient discharge
KW - Rehabilitation
KW - Skilled nursing facilities
UR - http://www.scopus.com/inward/record.url?scp=0034857756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034857756&partnerID=8YFLogxK
U2 - 10.1053/apmr.2001.24892
DO - 10.1053/apmr.2001.24892
M3 - Article
C2 - 11552183
AN - SCOPUS:0034857756
SN - 0003-9993
VL - 82
SP - 1151
EP - 1154
JO - Archives of physical medicine and rehabilitation
JF - Archives of physical medicine and rehabilitation
IS - 9
ER -