Rehospitalizations Five Years after Brain Injury

Past Studies

Past Studies indicate that individuals with disabilities tend to have higher medical costs than the general population. Healthcare providers are challenged to reduce the cost of medical care and rehabilitation. To keep costs down, there has been a trend for individuals to spend fewer days in the hospital and rehabilitation settings. Past studies show that individuals with disabilities have higher rates than the general population for returning to the hospital for medical care. One study found that up to 22.5% of individuals with traumatic brain injury are rehospitalized each year for the first three years following injury. In that study, about half of the rehospitalizations were for elective reasons. The most frequent causes of elective rehospitalizations were for bone and joint surgery, reconstructive surgery, infections, and general health maintenance. After the first year, the number of individuals with nonelective rehospitalizations increased. The most frequent reasons for nonelective rehospitalizations were seizures and mental health problems. Long-term medical problems, those severe enough to cause rehospitalization, for individuals with traumatic brain injury have not been determined.

This Study

This study included 895 individuals with traumatic brain injury from 17 Traumatic Brain Injury Model Systems rehabilitation centers. The researchers gathered information about the participants’ injuries their medical records. The researchers obtained data about the number of days spent in rehabilitation, admission and discharge functional abilities, payer source, medical complications, injury severity, and individual characteristics. Information about rehospitalization was obtained from participant and significant other interviews at one and five years after injury. The researchers found that rehospitalization rates were 23% at one year after the injury and 17% at five years after the injury. During the first year after injury, bone and muscle surgery and/or reconstructive surgery was the primary reason for a third of rehospitalizations. Many of these surgeries included the removal of medical hardware for fractures and the replacement of bone removed during brain surgery. During the fifth year after injury, such surgeries only accounted for 13% of rehospitalizations. Infection was the cause of ten percent of rehospitalizations during the first year and 8% at five years. Pneumonia was the leading type of infection at 43%. The second most common cause of infection was related to the medical hardware at 29%. Nonelective rehospitalizations increased from about 33% to 83% from years one to five. Rehospitalizations related to seizures, nervous system disorders, mental illness, and infections were classified as “nonelective.” The individuals that were rehospitalized with mental illness had not been hospitalized for that condition before.Discharge destination was the best predictor of rehospitalization. Individuals that were not rehospitalized were significantly more likely to be living in a private residence. The researchers suggest that individuals residing in skilled nursing facilities, group homes, or transitional living centers should be seen at more frequent intervals by health care providers to screen for medical complications. Individuals without insurance were rarely rehospitalized, accounting for only two unplanned admissions. The researchers found no relationships between rehospitalization and the number of days spent in rehabilitation, admission and discharge functional abilities, injury severity, and individual characteristics.

Who May Be Affected By These Findings

Individuals with traumatic brain injury, their significant others, healthcare providers, insurers, life care planners, and researchers.

Caveats

The researchers did not have data whether the admissions for mental illness were because of new problems or the result of the individuals’ experiences over several years after discharge from inpatient rehabilitation.

Bottom Line

The researchers found that there appears to be a stable rate of rehospitalization in years one to five, ranging from 22% to 17% per year. From years one to five, the number of individuals with rehospitalizations related to bone and joint surgery and reconstructive surgery decreased. The rehospitalization rates for individuals with seizures and mental illness increased.

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