title: Neurologic continuum of care: Evidence-based model of a post-hospital system of care.
abstract: BACKGROUND
  There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury.
  
  
  OBJECTIVE
  This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success.
  
  
  METHODS
  Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome.
  
  
  RESULTS
  Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome.
  
  
  CONCLUSIONS
  The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.
authors.affiliation: NeuroRestorative National Clinical Outcomes, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Lewis
authors.affiliation: NeuroRestorative National Clinical Outcomes, Florida State University, College of Medicine, Tallahassee, FL, USA.
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Horn
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods / Q000639:trends*; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D003266:Continuity of Patient Care / Q000639:trends*; D055317:Evidence-Based Practice / Q000379:methods / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000379:methods / Q000639:trends*; D012648:Self Care / Q000379:methods / Q000639:trends*
keywords: Brain injury; continuum of care; neurologic outcomes; post-hospital rehabilitation; predictors