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Kane WG, Wright DA, Fu R, Carlson KF. Racial/ethnic and insurance status disparities in discharge to posthospitalization care for patients with traumatic brain injury. The Journal of head trauma rehabilitation. 2014 Nov 1; 29(6):E10-7.
OBJECTIVES: Professional, posthospitalization care (PHC) can improve outcomes among patients with traumatic brain injury. We examined disparities in discharge to PHC by patients' race/ethnicity and insurance type. PARTICIPANTS: A total of 6061 adults hospitalized for unintentional traumatic brain injury in Oregon, 2008 to 2011. MAIN OUTCOME MEASURE: Posthospitalization care was assessed on the basis of discharge disposition. Multivariable logistic regression was used to estimate effects of race/ethnicity and insurance on referral to PHC while controlling for potential confounders. Generalized estimating equations were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), accounting for clustering of data by hospital. RESULTS: 28% of patients were discharged to PHC. While controlling for potential confounders, Hispanics were less likely to be discharged to PHC (OR, 0.62; CI, 0.40-0.96) than non-Hispanic whites. Compared with patients with private insurance, uninsured patients were less likely to be discharged to PHC (OR, 0.19; CI, 0.11-0.32) whereas patients with public insurance (OR, 1.65; CI, 1.33-2.05) and worker's compensation (OR, 1.66; CI, 1.09-2.52) were more likely to be discharged to PHC. CONCLUSIONS: Results suggest that racial/ethnic and insurance disparities exist in discharge to postacute care after hospitalization for traumatic brain injury. Future research should examine factors that might contribute to and reduce these inequities in care.