Neuropsychology and Neuroscience and TBI Lab, Kessler Foundation, East Hanover, NJ.
Department of Psychology, Rusk Institute of Rehabilitation, NYU Langone, New York, NY.
Arch Phys Med Rehabil. 2018 Nov;99(11):2365-2369. doi: 10.1016/j.apmr.2017.11.016. Epub 2018 Jan 6.
To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.
Cluster analysis of historical patient data obtained from inpatient visits.
Inpatient rehabilitation unit in a large urban university hospital.
Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury.
Not applicable.
We examined the membership of patients with traumatic brain injury in various "vulnerable group" clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge).
The cluster analysis revealed 4 major clusters (ie, clusters A-D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.
Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training, and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation after traumatic brain injury.
分析导致社会经济地位和医疗保健障碍的各种社会指标之间的复杂关系。
对从住院患者就诊中获得的历史患者数据进行聚类分析。
大型城市大学医院的住院康复病房。
接受急性住院治疗的成年患者（N=148），主要是闭合性颅脑损伤。
不适用。
我们检查了创伤性脑损伤患者在各种“弱势群体”群体（例如无家可归者、失业者、少数族裔）中的成员身份，并描述了患者的康复结果（例如，住院时间、入院至出院期间 FIM 评分的变化）。
聚类分析显示，根据弱势群体的成员身份，存在 4 个主要聚类（即聚类 A-D），它们的住院时间和 FIM 增益明显不同。聚类 B 是最大的聚类，也是由大多数少数族裔组成，其住院时间最短，在 4 个聚类中 FIM 改善程度最低，尽管入院时的 FIM 评分较高。在聚类 C 中，也主要由少数族裔组成，存在多种社会经济地位脆弱性，入院时患者的认知 FIM 评分较低，住院时间最长，FIM 评分改善良好。
聚类技术在住院数据中的应用确定了具有不同康复结果的不同患者聚类，这可能是由于他们属于不同的“高危”群体。结果确定了患者（即聚类 B，有少数族裔患者；聚类 D，有老年患者），他们在脑损伤康复方面的收益低于平均水平。结果还表明，系统（例如住院时间）或临床服务改进（例如员工的语言技能、提供药物滥用治疗、提供适当转介、与强化社会工作服务联系或计划亚急性康复阶段）可能对急性环境有益。也可以考虑采取更强的双语和多民族专业人员招聘、培训和留用计划，以优化创伤性脑损伤后急性住院康复的收益。
