Bukhari Rayyan A, Graham James E, Kinney Adam R, Hoffman Amanda, Malcolm Matt P
Department of Occupational Therapy Colorado State University, Fort Collins, Colorado (Mr Bukhari and Dr Graham); Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (Mr Bukhari); VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, Colorado (Dr Kinney); Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora (Dr Kinney); UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora (Ms Hoffman); and Rocky Mountain University of Health Professions, Provo, Utah (Dr Malcolm).
J Head Trauma Rehabil. 2023;38(2):156-164. doi: 10.1097/HTR.0000000000000817. Epub 2022 Oct 14.
To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI).
14 acute care hospitals in the state of Colorado.
We studied 5825 adults with TBI.
In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them.
Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services.
Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (-0.32 [-0.60, -0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service.
Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.
探讨社区层面的健康社会决定因素（SDoH）对因创伤性脑损伤（TBI）住院患者接受职业治疗（OT）和物理治疗（PT）服务起始情况的影响。
科罗拉多州的14家急症护理医院。
我们研究了5825名患有TBI的成年人。
在对去识别化电子健康记录数据进行的二次分析中，我们进行了多变量逻辑回归和线性回归，以计算接受服务的可能性的比值比（OR）和95%置信区间（CI），以及接受服务者开始接受服务的时长。
社区层面的SDoH、康复服务的接受情况以及康复服务的起始情况。
多变量逻辑回归和线性回归显示，社区收入处于前四分位数的人群与接受OT服务的时长相关，与最低四分位数人群相比，四分位数2的OR = 0.33 [95% CI，0.07，0.60]，四分位数4的OR = 0.76 [0.44，1.08]。只有前四分位数在接受PT服务的时长方面存在显著差异（0.63 [0.28，0.98]）。相对于社区高中文凭比例中位数以下的人群，中位数以上的人群仅与接受PT服务的时长相关（-0.32 [-0.60，-0.04]）。社区学士学位比例和城乡划分与接受这两种治疗服务的时长均无关联。
需要进一步研究以确定我们的SDoH变量是否过于分散，无法捕捉个体经历及其对护理的影响，或者社区层面的教育、收入和农村/城市属性是否真的不会影响TBI住院患者接受治疗的时间。其他个体层面的变量，如年龄、合并症负担和TBI严重程度，与治疗起始情况呈现出明显的关系。这些发现可能有助于治疗师评估并规范及时获得康复服务的公平性。
