Cluster Analysis of Vulnerable Groups in Acute TBI Rehabilitation

Details

• Alternative Title:
  Arch Phys Med Rehabil
• Personal Author:
  Kucukboyaci, N. Erkut ; Long, Coralynn ; Smith, Michelle ; Rath, Joseph F. ; Bushnik, Tamara
• Description:
  Objective
  
  To analyze the complex relationship between various social indicators that contribute to socioeconomic status and healthcare barriers.
  
  Design
  
  Cluster analysis of historical patient data obtained from inpatient visits.
  
  Setting
  
  Inpatient rehabilitation unit in a large, urban university hospital.
  
  Participants
  
  Adult patients receiving acute inpatient care, predominantly for closed head injury.
  
  Interventions
  
  Not applicable
  
  Main outcome measures
  
  We examined the membership of TBI patients in various “vulnerable group” (VG) clusters (e.g., homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of the patients (e.g., duration of stay, changes in Functional Independence Measure [FIM] scores between admission to inpatient stay and discharge).
  
  Results
  
  Analysis revealed four major clusters (i.e., Clusters A-D) separated by VG memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the four clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple SES vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.
  
  Conclusions
  
  Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various “at-risk” groups. Results identified patients (i.e., cluster B, with minority patients and Cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. Results also suggested that systemic (e.g., duration of stay) or clinical service improvements (e.g., staff’s language skills, ability to offer substance abuse therapy, provide appropriate referrals or liaise with intensive social work services or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation following traumatic brain injury.
  
  
• Subjects:
  Adult Aged Article At-risk And Vulnerable Groups Brain Injuries, Traumatic Cluster Analysis Disability Evaluation Diversity Ethnic Groups Female Health Services Accessibility Humans Inpatient Care Inpatients Length Of Stay Male Middle Aged Minorities Rehabilitation Rehabilitation Centers Socio-economic Status Socioeconomic Factors Treatment Outcome Vulnerable Populations

  More +
• Source:
  Arch Phys Med Rehabil. 99(11):2365-2369
• Pubmed ID:
  29317223
• Pubmed Central ID:
  PMC6581442
• Document Type:
  Journal Article
• Funding:
  90ARHF0001/ACL HHS/United States ; 90DP0047/ACL HHS/United States ; U48 DP000047/DP/NCCDPHP CDC HHS/United States
• Volume:
  99
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9c2f7bd2516cd82e2cf0718cd64e745753694234767d83e695f96ea812daf73d
• Download URL:
  https://stacks.cdc.gov/view/cdc/79249/cdc_79249_DS1.pdf
• File Type:
  [PDF - 390.44 KB ]