1543 - Sociodemographic Disparities in Time to Utilization of Community-Based Rehabilitation Services among Medicare Fee-for-Service Beneficiaries with Traumatic Brain Injury

Objectives: To examine the association between sociodemographics and time to first outpatient rehabilitation or home health (HH) visit after hospital discharge by specialty among Medicare Fee-for-Service beneficiaries hospitalized for traumatic brain injury (TBI).

Design: Using 100% Texas Medicare claims data, a retrospective cohort analysis included 19,742 patients aged 66 years or older who were hospitalized for a TBI between 1/1/2014 to 12/31/2018. Cox proportional hazard regression and Fine-Gray competing risk models examined separately time to first HH or outpatient physical therapy (PT), occupational therapy (OT), speech/language therapy (SLT), and social/psychological visits, with censoring while accounting for competing risks of death, hospitalization, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), nursing home (NH) and hospice care.

Results: Roughly 22% of patients were ethnic and racial minorities, 57% female, 71% aged 75+, and 16% Medicare/Medicaid dual eligible. Patients aged 85 and older (vs. 66-74) received PT [HR=1.36 (1.30-1.43)], OT [HR=1.40(1.31-1.50)] and SLT [HR=1.24(1.11-1.39)] earlier; however, greater time was taken to receive social/psychological services [HR=0.76 (0.66-0.87)]. Females utilized PT, OT or social/psychological services sooner and greater time to utilize SLT compared to males. Compared to non-Hispanic White patients, non-Hispanic Black [HR=0.88 (0.80-0.96)] and Hispanic patients [HR=0.90(0.85-0.96)] received their first PT visit in greater time. Medicare/Medicaid dual eligible patients (vs. Medicare only) received their first PT, OT, and SLT visit in greater time after discharge. Overall, patients who previously received care at either a SNF, IRF, acute hospital, or NH had their first PT or OT visit quicker than patients discharged home without HH.

Conclusions: Among older patients with TBI who return home following hospital discharge, we found sociodemographic differences in time to first outpatient rehabilitation or home health visit. This could be indicative of differing manifestations of symptoms between or specific rehabilitation needs in specific groups. Recognition of these patterns could inform rehabilitation recommendations.