Department of Health Services, Policy and Practice Center for Gerontology and Healthcare Research, Brown School of Public Health (Drs Evans, Resnik, and Thomas) and Department of Biostatistics (Dr Gutman and Mr DeVone), Brown University School of Public Health, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island (Drs Resnik and Thomas); Departments of Emergency Medicine and Pediatrics (Dr Zonfrillo) and Division of Acute Care Surgery and Surgical Critical Care, Rhode Island Hospital (Dr Lueckel), Warren Alpert School of Medicine of Brown University, Providence, Rhode Island; and Department of Rehabilitation and Human Performance (Drs Kumar and Dams-O'Connor) and Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York.
J Head Trauma Rehabil. 2021;36(3):E186-E198. doi: 10.1097/HTR.0000000000000638.
To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI).
Skilled nursing facilities.
Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI.
Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach.
Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility.
Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race "other" was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fall-related injury mechanism were not associated with successful discharge.
Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post-acute care.
确定与老年创伤性脑损伤（TBI）住院后在熟练护理机构（SNF）停留后成功出院到社区相关的患者、损伤和功能状态特征。
熟练护理机构。
接受 SNF 治疗的 Medicare 按服务收费受益人的 TBI 住院后。
使用 Medicare 管理数据与国家创伤数据银行使用多层贝叶斯记录链接方法合并的回顾性队列研究。
成功社区出院：在 SNF 入院后 100 天内出院并在社区中存活 30 天或以上，无死亡或入住医疗机构。
医疗补助计划参与、失禁、日常生活活动独立性下降和认知障碍与成功出院的可能性较低相关，而种族“其他”与成功出院的可能性较高相关。损伤因素，包括更严重的损伤严重程度（格拉斯哥昏迷量表和简明损伤评分）和与跌倒相关的损伤机制，与成功出院无关。
在出院至 SNF 的老年 TBI 患者中，社会人口统计学和功能状态特征与成功出院相关，这可能对临床医生进行出院计划有用。一旦患者因急性后护理而被收治到 SNF，急性损伤严重程度指数在预测出院处置方面可能作用有限。
