Care Patterns and Predictors of Community Residence after Hospital Discharge among Older Patients with TBI

Research Objectives: To examine residential status over 20 weeks following acute hospital discharge for TBI and identify factors associated with community residence and readmission at 90 days.

Design: Secondary data analysis of 100% Texas Medicare claims data.

Setting: Acute hospital, inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care nursing home (NH), and community.

Participants: Medicare patients aged 66 years and older hospitalized for a TBI from January 1, 2014, through December 31, 2017, and followed for 20 weeks following discharge.

Interventions: None.

Main Outcome Measures: Community residence (i.e., not residing in any inpatient or nursing home facility) and all-cause readmission at 90 days following discharge.

Results: Of the 26,985 older patients with TBI (57.3% Female; 21.1% Ethnic/racial minorities), 80% were living in the community by 90 days and 84% by 20 weeks following discharge. Females (OR=1.16 [1.08-1.25]) vs males, Hispanics (OR=2.01 [1.80-2.25]) or other race/ethnicity (OR=2.19 [1.73-2.77]) vs non-Hispanic white (NHW), or with a preadmission primary care provider (PCP) (OR=1.51[1.40-1.62]) vs not, were more likely to reside in the community at 90 days following discharge. Factors associated with decreased odds of community residence at 90 days were: Patients aged 75-79 (OR = 0.65 [0.56-0.76]), 80-84 (OR = 0.57 [0.49-0.65]), 85-89 (OR = 0.47 [0.40-0.54]), and 90+ (OR = 0.36 [0.31-0.41]) vs those aged 66-69; previously residing in a NH (OR = 0.09 [0.07-0.10]) vs community; dual eligibility (OR = 0.16 [0.15-0.18]) vs not; previous TBI (OR = 0.87 [0.81-0.94]) vs not; or more severe trauma injury scores (OR = 0.82 [0.75-0.91]) vs milder injury scores. Non-Hispanic Blacks (HR=1.33 [1.20-1.46]) vs NHW, and SNF (HR=1.56 [1.48-1.65]) or IRF (HR=1.49 [1.40-1.59]) vs discharged home, dual eligible (HR=1.11[1.04-1.18]) vs not, previous TBI (HR=1.05[1.01-1.10]) vs not, and PCP (HR=1.23 [1.17-1.30]) vs not, had greater 90-day readmission rates.

Conclusions: Most older adults with TBI returned to the community following hospital discharge. Disparities exist in returning to the community and in risk of 90- day readmission following hospital discharge.

Author(s) Disclosures: None disclosed.