Author

Wendy Kane

Date

June 2013

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

BACKGROUND: Post-hospitalization care has been shown to improve short- and long-term outcomes as well as quality of life among patients who sustain traumatic brain injury (TBI). We examined racial/ethnic and insurance disparities in post-hospitalization care among adults hospitalized for TBI in the state of Oregon. METHODS: We utilized data from the Oregon Hospital Discharge Data Index for the four-year period 2008-2011. Patients hospitalized for unintentional TBI were identified based on diagnosis and external cause of injury codes. Receipt of post-hospitalization care was assessed using “discharge disposition,” indicating whether the patient was discharged home or to post-hospitalization care. We characterized the proportions of patients discharged to post-hospitalization care by patient characteristics. Multivariable logistic regression was used to assess the association between receiving post-hospitalization care and race/ethnicity and insurance status while controlling for potential confounders. Clustering of data by hospital was accounted for using generalized estimating equations. RESULTS: A total of 6,997 patients were included in analyses. Overall, 28% of patients were discharged to post-hospitalization care; this proportion was greater for Non-Hispanic Whites (32%) than Non-Hispanic Other (20%), Non-Hispanic Black (17%) and Hispanic patients (11%). Few uninsured patients were discharged to post-hospitalization care (3%). While controlling for potential confounders, Hispanics were less likely discharged to post-hospitalization care (OR 0.62; CI 0.42-0.91) than Non-Hispanic Whites. Compared to patients with private insurance, uninsured patients were less likely discharged to post-hospitalization care (OR 0.21; CI 0.11 - 0.41) while patients with public insurance (OR 1.74; CI 1.42 - 2.14) and worker’s compensation (OR 1.57; CI 1.13 - 2.18) were more likely to be discharged to post-hospitalization care. CONCLUSIONS: This study suggests racial/ethnic and insurance status disparities exist with regard to receiving post-acute care after hospitalization for TBI. Future research should examine factors that might contribute to and reduce these inequities in care.

Identifier

doi:10.6083/M4DF6P85

School

School of Medicine

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