(Research Hub Theater) Predictors of Utilization of Home Health and Outpatient Rehabilitation Services Among Medicare Fee-for-Service Beneficiaries After Traumatic Brain Injury: A Retrospective Analysis

Background and/or Objectives: To examine the association between sociodemographics and utilization of home health (HH) or outpatient rehabilitation services following community discharge among Medicare Fee-for-Service beneficiaries hospitalized for traumatic brain injury (TBI) in Texas.

Design: Retrospective cohort analysis using 100% Texas Medicare claims data. Cox proportional hazard regression and Fine-Gray competing risk models examined time to first HH or outpatient rehabilitation visit censored at end of follow-up or loss of insurance, while accounting for competing risks of death, hospitalization, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), nursing home (NH) and hospice care.

Setting: Community.

Participants: Patients aged 66 years or older who were hospitalized (1/1/2014-12/31/2018) with a TBI diagnosis and returned to the community within 90 days of discharge.

Interventions: Not applicable.

Main Outcome Measures: First HH or outpatient rehabilitation visit (i.e., physical therapy (PT), occupational therapy (OT), speech/language therapy (SLT), and social/psychological services) following community discharge.

Results: Among the 19,742 Medicare-Fee-for-Service beneficiaries, roughly 22% of patients were ethnic and racial minorities, 57% female, 71% aged 75+, and 16% Medicare/Medicaid dual-eligible. 38% of patients did not receive any rehabilitation services following community discharge. Of those who received at least one rehabilitation service, 59.4% received PT, 31.4% received OT, 12.6% received SLT, and 7.3% received social/psychological services. Older patients who are Black (HR=0.87;95%CI=[0.79-0.95]), Hispanic (HR=0.87;95%CI=[0.83-0.93]), or Medicare/Medicaid dual-eligible (HR=0.84;95%CI=[0.83-0.93]) were associated with greater time to first HH/outpatient rehabilitation visit after community discharge. Less time to first rehabilitation visit was associated with patients aged 75-84 [HR=1.21;95%CI)=[1.16-1.26] and 85+ years (HR=1.32;95%CI=[1.26-1.38]) compared to younger patients, females (HR=1.12;95%CI=[1.08-1.17]), prior TBI history (HR=1.05;95%CI=[1.02-1.09]), and greater comorbidities, trauma scores, and those discharged to inpatient settings (i.e., HH, IRF, SNF, NH or hospital) compared to home.

Conclusions: Disparities exist in time to rehabilitation services following community discharge, indicating the need to improve timely access to rehabilitation services for marginalized racial and ethnic groups and dual-eligible Medicare/Medicaid beneficiaries.