National Healthcare Quality and Disparities Report
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- Adverse Events (3)
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- Transitions of Care (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedWu A, Zhou J, Quinlan N
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
The purpose of this study was to identify variables and outcomes related to inpatient palliative care (PC) consultation for patients age 65+ with traumatic brain injuries (TBI). The researchers included individuals over age 65 presenting from January 2013-September 2020 with TBI and intracranial hemorrhage. The study found that inpatient PC consultation was uncommon; with only 4% of 576 patients receiving. Features associated with likelihood of consultation were severe TBI and pre-existing dementia. Patients with PC consults had longer overall and intensive care unit (ICU) length of stays (LOS), more days intubated and higher costs. However, those patients with earlier-than-average PC consultation had shorter overall and ICU LOS as well as fewer ventilator days on a ventilator and lower costs. The study concluded that older patients with TBI have a greater likelihood of receiving PC consultation based on pre-existing dementia and severe TBI and patients with PC consultations had worse LOS and higher costs, but those impacts were diminished by earlier involvement from the PC.
AHRQ-funded; HS028747.
Citation: Wu A, Zhou J, Quinlan N .
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
J Clin Neurosci 2023 Feb; 108:1-5. doi: 10.1016/j.jocn.2022.12.013..
Keywords: Elderly, Palliative Care, Hospitalization, Brain Injury
Evans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Kumar RG, Zhang W, Evans E
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
The objective of this study was to describe patient, hospital, and geographic characteristics of older adult Medicare beneficiaries who were hospitalized with traumatic brain injury (TBI) then admitted to long-term acute care hospitals. Participants were predominantly White males with an average age of 77.1. Average acute hospital length of stay was 19.4 days. Only 4% of patients were discharged home after a long-term acute care hospital stay; the primary discharge disposition was to skilled nursing facilities. Geographic analyses indicated that Southern and Midwestern states had the greatest number of long-term acute care hospital facilities and highest proportion of admissions. The authors concluded that more research is needed to understand long-term functional outcomes among this population.
AHRQ-funded; HS000011.
Citation: Kumar RG, Zhang W, Evans E .
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
J Head Trauma Rehabil 2022 Mar-Apr; 37(2):89-95. doi: 10.1097/htr.0000000000000685..
Keywords: Elderly, Brain Injury, Long-Term Care
Anderson MC, Evans E, Zonfrillo MR
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
This study compared differences in outcomes for older adults with traumatic brain injury (TBI) in rural and urban settings by 1) comparing the rates of successful community discharge; and 2) reasons for not achieving successful discharge. This retrospective national cohort study looked at skilled nursing facility (SNF) patients aged 66 and older using Medicare inpatient claims with Minimum Data Set assessments. A total of 11,771 SNFs were identified with a total population of 61,021 Medicare beneficiaries discharged to a SNF following hospitalization for TBI between 2011 and 2015. Patients in rural settings had lower rates of successful discharge compared with patients in urban settings (52.1% vs 58.5%). Reasons for unsuccessful discharge differed between rural and urban settings with rural patients less likely to discharged from SNF within 100 days although they were less likely to be rehospitalized within 30 days of SNF discharge.
AHRQ-funded; HS000011.
Citation: Anderson MC, Evans E, Zonfrillo MR .
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
J Am Geriatr Soc 2021 Jun;69(6):1601-08. doi: 10.1111/jgs.17065..
Keywords: Elderly, Brain Injury, Trauma, Rural Health, Urban Health, Rehabilitation, Nursing Homes
Evans E, Gutman R, Resnik L
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
The purpose of this retrospective cohort study was to identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). Participants were Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. Findings showed that among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning.
AHRQ-funded; HS000011.
Citation: Evans E, Gutman R, Resnik L .
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
J Head Trauma Rehabil 2021 May-Jun;36(3):E186-e98. doi: 10.1097/htr.0000000000000638..
Keywords: Elderly, Brain Injury, Transitions of Care, Nursing Homes
Adediran T, Drumheller BC, McCunn M
Sex differences in in-hospital complications among older adults after traumatic brain injury.
This study examined sex differences in in-hospital complications among older adults after traumatic brain injury (TBI). Previous evidence has suggested that women have better outcomes than men after TBI. A retrospective cohort study was conducted of adults aged 65 years and older treated for moderate to severe TBI at R. Adams Cowley Shock Trauma Center from 1996 to 2012. The investigators identified TBI using ICD-9 CM codes and inclusion in the study required an abbreviated injury scale head score of 3 or greater, abbreviated injury scale scores for other body regions of 2 or greater, and a blunt injury mechanism. Out of 2511 patients, 51.1% were men, and 25.1% developed an in-hospital complication. Men had a complication rate of 28.1% versus 22.0% for women.
AHRQ-funded; HS024560.
Citation: Adediran T, Drumheller BC, McCunn M .
Sex differences in in-hospital complications among older adults after traumatic brain injury.
J Surg Res 2019 Nov;243:427-33. doi: 10.1016/j.jss.2019.05.053..
Keywords: Elderly, Sex Factors, Adverse Events, Hospitalization, Brain Injury
Vadlamani A, Perry JA, McCunn M
Racial differences in discharge location after a traumatic brain injury among older adults.
The purpose of this retrospective cohort study was to determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center. The authors concluded that in this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.
AHRQ-funded; HS024560.
Citation: Vadlamani A, Perry JA, McCunn M .
Racial differences in discharge location after a traumatic brain injury among older adults.
Arch Phys Med Rehabil 2019 Sep;100(9):1622-28. doi: 10.1016/j.apmr.2019.03.008.
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Keywords: Racial and Ethnic Minorities, Brain Injury, Trauma, Elderly, Hospital Discharge, Rehabilitation, Medicare
Glass NE, Vadlamani A, Hwang F
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
The objectives of this study were to evaluate the incidence of bleeding, recurrent traumatic brain injury (TBI), and thromboembolic (TE) events after an initial TBI in older adults and to identify which factors contribute to this risk. The researchers found that, among Medicare patients hospitalized with TBI, the incidence of TE events was significantly higher than that of bleeding or recurrent TBI. They identified specific risk factors of bleeding and TE events, which may guide care of older adults after TBI.
AHRQ-funded; HS024560.
Citation: Glass NE, Vadlamani A, Hwang F .
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
J Surg Res 2019 Mar;235:615-20. doi: 10.1016/j.jss.2018.10.021..
Keywords: Brain Injury, Blood Clots, Elderly, Trauma, Injuries and Wounds, Risk, Adverse Events
Albrecht JS, Perfetto EM, Daniel Mullins C
Safety of antidepressant classes used following traumatic brain injury among Medicare beneficiaries: a retrospective cohort study.
The objective of this study was to compare the risk of several adverse events associated with use of the three most commonly used classes of antidepressants following Traumatic Brain Injury (TBI) in older adults. One of the study’s conclusions was that compared to tricyclic antidepressants, selective serotonin reuptake inhibitor use was associated with increased risk of hemorrhagic stroke.
AHRQ-funded; HS024560
Citation: Albrecht JS, Perfetto EM, Daniel Mullins C .
Safety of antidepressant classes used following traumatic brain injury among Medicare beneficiaries: a retrospective cohort study.
Drugs Aging 2018 Aug;35(8):763-72. doi: 10.1007/s40266-018-0570-2..
Keywords: Adverse Events, Medication, Brain Injury, Elderly, Patient Safety
Albrecht JS, Slejko JF, Stein DM
Treatment charges for traumatic brain injury among older adults at a trauma center.
The objective of this study was to provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults 65 years and older treated at a trauma center. The study provided the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Slejko JF, Stein DM .
Treatment charges for traumatic brain injury among older adults at a trauma center.
J Head Trauma Rehabil 2017 Nov/Dec;32(6):E45-e53. doi: 10.1097/htr.0000000000000297..
Keywords: Brain Injury, Elderly, Healthcare Costs, Hospitalization, Patient-Centered Outcomes Research
Albrecht JS, Mullins DC, Smith GS
Psychotropic medication use among Medicare beneficiaries following traumatic brain injury.
The researchers characterized psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. They found that average monthly prevalence of psychotropic medication use among all patients hospitalized for TBI was 44.8 percent; antidepressants constituted 73 percent. Following TBI, psychotropic medication use increased slightly.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Mullins DC, Smith GS .
Psychotropic medication use among Medicare beneficiaries following traumatic brain injury.
Am J Geriatr Psychiatry 2017 Apr;25(4):415-24. doi: 10.1016/j.jagp.2016.11.018.
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Keywords: Brain Injury, Elderly, Hospitalization, Medication, Behavioral Health
Albrecht JS, McCunn M, Stein DM
Sex differences in mortality following isolated traumatic brain injury among older adults.
This retrospective cohort study's objective was to determine the possibility of sex differences in mortality among older adutls following isolated traumatic brain injury (TBI) and to comapre with findings using all TBI. The researchers did not find that women were significantly associated with decreased odds of mortality following isolated TBI.
AHRQ-funded; HS024560.
Citation: Albrecht JS, McCunn M, Stein DM .
Sex differences in mortality following isolated traumatic brain injury among older adults.
J Trauma Acute Care Surg 2016 Sep;81(3):486-92. doi: 10.1097/ta.0000000000001118.
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Keywords: Sex Factors, Trauma, Brain Injury, Mortality, Elderly
Bekelis K, Gottlieb D, Su Y
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
The authors studied elderly Medicare patients who underwent treatment for ruptured cerebral aneurysms. They did not demonstrate a difference in mortality, rate of discharge to rehabilitation, and readmissions between surgical clipping and endovascular coiling of ruptured cerebral aneurysms, although clipping was associated with a slightly longer length of stay.
AHRQ-funded; HS021581.
Citation: Bekelis K, Gottlieb D, Su Y .
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
J Neurointerv Surg 2016 Sep;8(9):913-8. doi: 10.1136/neurintsurg-2015-011890.
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Keywords: Brain Injury, Surgery, Comparative Effectiveness, Outcomes, Elderly
Flottemesch TJ, Raetzman S, Heslin KC
AHRQ Author: Heslin KC
Age-related disparities in trauma center access for severe head injuries following the release of the updated field triage guidelines.
Reflecting perceived undertriage to trauma centers (TCs) for older adults, the American College of Surgeons' Committee on Trauma and the Center for Disease Control revised field triage guidelines in 2011 with additional emphasis on direct transport to a Level I or II trauma center. Researchers examined whether age-based disparities in TC care for severe head injury decreased. Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Flottemesch TJ, Raetzman S, Heslin KC .
Age-related disparities in trauma center access for severe head injuries following the release of the updated field triage guidelines.
Acad Emerg Med 2016 Apr;24(4):447-57. doi: 10.1111/acem.13150.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Elderly, Brain Injury, Emergency Medical Services (EMS)