title: Discharge disposition from acute care after traumatic brain injury: the effect of insurance type.
abstract: OBJECTIVE
  To determine if persons with traumatic brain injury (TBI) who are insured by Medicaid or health maintenance organizations (HMOs) are more likely to receive postacute care in skilled nursing facilities (SNFs) than in rehabilitation facilities, compared with persons insured by commercial fee-for-service (FFS) plans.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  County hospital admitting 30% of all Washington State TBI patients.
  
  
  METHODS
  Patients with moderate to severe TBI discharged to rehabilitation facilities or SNFs between 1992 and 1997 (n = 1271); 56.3% were insured by Medicaid, 26.1% by FFS plans, and 17.6% by HMOs.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Disposition on discharge from acute care (rehabilitation facilities vs SNF); adjusted relative risk (RR) and confidence interval (CI) for different insurance types.
  
  
  RESULTS
  After accounting for confounding factors, Medicaid patients were 68% more likely (RR = 1.68, 95% CI = 1.34-2.11) and HMO patients were 23% more likely (RR = 1.23, 95% CI =.90-1.68) to go to a SNF than FFS patients. However, the latter difference was not statistically significant.
  
  
  CONCLUSIONS
  An association exists between insurance type and postacute care site. Efforts should be made to determine the effect this relationship has on the cost and outcomes for TBI patients.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98185, USA. leighton@u.washington.edu
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: J
authors.initials: J
authors.lastname: Doctor
authors.forename: N
authors.initials: N
authors.lastname: Temkin
authors.forename: R F
authors.initials: RF
authors.lastname: MacLehose
authors.forename: P
authors.initials: P
authors.lastname: Esselman
authors.forename: K
authors.initials: K
authors.lastname: Bell
authors.forename: S
authors.initials: S
authors.lastname: Dikmen
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000191:economics; D000368:Aged; D001930:Brain Injuries / Q000145:classification / Q000191:economics* / Q000534:rehabilitation*; D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000145:classification*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D019467:Subacute Care / Q000191:economics*; D014861:Washington