Oyesanya Submits Center for Large Data Research and Data Sharing in Rehabilitation, University of Texas Medical Branch Proposal

Kudos to Tolu Oyesanya, assistant professor, and her entire team for their submission to the Center for Large Data Research and Data Sharing in Rehabilitation, University of Texas Medical Branch for a proposal entitled “Trends and Predictors of Poor Discharge Outcomes following Inpatient Rehabilitation for Adults with Traumatic Brain Injury." This proposal requests funding for a one-year period with a start date of July 1, 2019.

Value-based health care is leading more healthcare providers to demonstrate positive patient outcomes following an episode of care.1–3 The pressure is greatest for providers of inpatient rehabilitation.1–3 Although care in inpatient rehabilitation facilities (IRF) is recognized as beneficial for patients who experience functional loss after illness, injury, or surgery, it is the most expensive type of post-acute rehabilitation.1–3 Among all conditions treated in IRFs, the percent of Medicare IRF cases from 2004 to 2016 with neurological conditions and brain injury increased more than all others.2 There is a critical need to study outcomes for brain injury patients as the population of brain injury patients in IRFs has doubled in just over a decade. Poor discharge rehabilitation outcomes for patients with traumatic brain injury (TBI), including limited gain in cognitive and motor function over the IRF stay and the inability to return to home/community after IRF care can negatively affect downstream health and burden family and informal caregivers.4,5 Yet, few scholars have examined trends and predictors of poor discharge rehabilitation outcomes for adults with TBI. These evidence gaps limit the ability to identify strategies and design interventions to address any disparities in outcomes. In this study, we will use 16 years’ of data (2002-2018) from Uniform Data System for Medical Rehabilitation (UDSMR)6 to examine outcomes for adult patients with TBI (age >18 years) who received IRF care. More specifically, we aim to investigate contemporary trends in outcomes and patient and facility characteristics that predict discharge rehabilitation outcomes for adults with TBI who received IRF care. Our findings will contribute to outcomes research for adults with TBI who received IRF care, inform providers of factors increasing odds of poor discharge outcomes, and will be used by our team to develop interventions aimed to address needs, allocation of resources, and transitional care planning.

Specific Aims: Our overall goal is to examine outcomes for adult patients with TBI who received IRF care between 2002 and 2018 using UDSMR data. Findings will inform interventions for transitional care planning. Aim 1a. To describe contemporary trends in discharge rehabilitation outcomes (discharge living setting and cognitive and motor function) for adult patients with TBI who received IRF care from 2002-2018.

Hypothesis 1a: Hospital readmissions and discharge to skilled nursing facilities will increase and FIM cognitive and motor gains will not significantly change over the 16-years (2002-2018). Aim 1b. To identify patient and facility characteristics that are associated with discharge rehabilitation outcomes.

Hypothesis 1b: Younger age, male sex, fewer comorbidities, and free-standing facilities (vs. units) will be associated with larger gains in cognitive and motor functioning and higher odds of discharge to home/community after adjusting for IRF length of stay.