Relationship of Rehabilitation Insurance Payor to Functional Status At 1-Year Post Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

Abstract

To determine the contribution of insurance status during inpatient rehabilitation to 1-year functional outcomes in individuals with moderate to severe traumatic brain injury. Post-inpatient rehabilitation discharge. 8,285 individuals with medically documented moderate to severe TBI who had received acute trauma care and inpatient rehabilitation (5,234 Non-Hispanic Whites; 1,329 Non-Hispanic Blacks; 1,303 Hispanics, 280 Asians, 184 Other). Multicenter prospective cohort study. Functional Independence Measure (FIM), motor and cognitive domains. After adjusting for demographic and injury characteristics, individuals with Medicaid, individuals under age 65 with Medicare, and those with workman's compensation/auto as their primary insurance had worse FIM cognitive and motor scores at 1-year post-injury, relative to those with private insurance/self-pay. An interaction was observed between insurance payor and length of rehabilitation stay, such that the most profound differences in 1-year FIM scores between individuals with private insurance vs. individuals under 65 with Medicare were among persons with ≥ 30 days length of stay. Those with Medicaid and those who were 65+ with Medicare and no secondary insurance also had lower FIM motor scores than those with private insurance, particularly if their length of stay was ≥ 30 days. Functional outcomes at 1-year post-TBI differ based on insurance type, with relatively poorer functional outcomes among those with public health insurance or workman's compensation/auto insurance. This association was greater among patients with the longest rehabilitation lengths of stay which likely indicates greater medical complexity. Potential reasons may be less access to post-discharge therapies, but insurance payor could also be a proxy for socioeconomic position, family support, community resources, and/or neighborhood disadvantages. Individuals in these payor groups may require targeted social work, care coordination, and/or resource facilitation to improve functional outcomes.