title: Racial/ethnic and insurance status disparities in discharge to posthospitalization care for patients with traumatic brain injury.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A total of 6061 adults hospitalized for unintentional traumatic brain injury in Oregon, 2008 to 2011.
  
  
  METHODS
  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.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon (Ms Kane and Drs Wright, Fu, and Carlson); Injury and Violence Prevention Section, Center for Prevention and Health Promotion, Oregon Health Authority, Portland, Oregon (Dr Wright); Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), Portland, Oregon (Dr Carlson).
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Kane
authors.forename: Dagan A
authors.initials: DA
authors.lastname: Wright
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Carlson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000191:economics / Q000208:ethnology / Q000534:rehabilitation*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009922:Oregon; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data*; D012923:Social Class; D016896:Treatment Outcome; D055815:Young Adult