Care After Hospitalization for Traumatic Brain Injury

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Traumatic brain injury (TBI) is an injury that causes damage to the brain. A concussion is mild TBI. Although TBI is often associated with contact sports, such as football, or warfare because of the exposure to explosions and gunfire, it can occur in everyday life when someone falls, is in a motor vehicle accident or gets struck by an object of some kind — a heavy object tumbling off a high shelf and hitting someone on the head for example, The symptoms range from headaches to insomnia to fatigue to loss of motor control and also vary in how long they last. Older people who experience TBI tend to have symptoms that last long longer and experience worse outcomes, a pattern that invites questions about what kind of care older people with TBI receive over long term.

A study published in the June 2023 issue of the Journal of the American Geriatrics Society examined a facet of that issue. Monique R. Pappadis, Ph.D., an associate professor in the Department of Population Health and Health Disparities, School of Public and Population Health, at the University of Texas Medical Branch at Galveston, and her colleagues used Medicare claims data to identify 26,985 Medicare fee-for-service patients who had been admitted to an acute care hospital for TBI sometime between Jan. 1, 2014, and Dec. 31, 2017. Then they looked at the claims further to identify where they were discharged to. Of those who survived, almost half (46%) were discharged directly to the community and about one-third (30%) to a skilled nursing facility (SNF). The remainder were discharged to an inpatient rehabilitation facility (17%) or another hospital or long-term care nursing home (7%).

Monique Pappadis, Ph.D.

When Pappadis and her colleagues looked at people’s status 90 days after discharge, 80% of the formerly hospitalized patients were living in the community. They noted that a sharp drop in the number of patients in skilled nursing facilities three weeks after discharge was likely associated with a Medicare coinsurance policy that increases the coinsurance per day from zero to $194 on day 21 of skilled nursing facility care.

The researchers also sifted through data organized by demographic groups to identify some usage patterns and readmission rates by gender, race and ethnicity, and age. Female sex, Hispanic ethnicity and having a primary care provider were associated with increased likelihood of living in the community 90 days after discharge. Being 75 or older, having a prior TBI diagnosis and moderate-to-severe injury were associated with decreased likelihood of living in the community 90 days after discharge.

Pappadis and her colleagues noted that regardless of age, Hispanic patient with TBIC were less likely to receive post-injury rehabilitation services. Patient preference and cultural values may be a factor, they said, but they floated the idea that language barriers and racism may be factors along with family support and the lack of nearby facilities.