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. 2023 Mar-Apr;38(2):156-164.
doi: 10.1097/HTR.0000000000000817. Epub 2022 Oct 14.

Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

Rayyan A Bukhari  1 , James E Graham, Adam R Kinney, Amanda Hoffman, Matt P Malcolm
Affiliations

Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

Rayyan A Bukhari et al. J Head Trauma Rehabil. 2023 Mar-Apr.

Abstract

Objective: To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI).

Setting: 14 acute care hospitals in the state of Colorado.

Participants: We studied 5825 adults with TBI.

Design: In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them.

Main measures: Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services.

Results: Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (-0.32 [-0.60, -0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service.

Conclusion: Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

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