title: Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes.
abstract: To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes.
  
  
  
  Multicenter observational cohort study.
  
  
  
  TBIMS centers.
  
  
  
  Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003-2012 (N=5505).
  
  
  
  Not applicable.
  
  
  
  Functional outcomes of patients with TBI.
  
  
  
  Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds.
  
  
  
  Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.
authors.affiliation: Baylor Institute for Rehabilitation, Dallas, TX; North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Center for Medical Psychology, Baylor Regional Medical Center of Plano, Plano, TX.
authors.forename: Marie N
authors.initials: MN
authors.lastname: Dahdah
authors.affiliation: Baylor Institute for Health Care Research and Improvement, Dallas, TX.
authors.forename: Sunni
authors.initials: S
authors.lastname: Barnes
authors.affiliation: Baylor Institute for Health Care Research and Improvement, Dallas, TX.
authors.forename: Amy
authors.initials: A
authors.lastname: Buros
authors.affiliation: Baylor Institute for Rehabilitation, Dallas, TX; North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dubiel
authors.affiliation: North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Dunklin
authors.affiliation: North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX.
authors.forename: Librada
authors.initials: L
authors.lastname: Callender
authors.affiliation: North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX.
authors.forename: Caryn
authors.initials: C
authors.lastname: Harper
authors.affiliation: Baylor Institute for Rehabilitation, Dallas, TX.
authors.forename: Amy
authors.initials: A
authors.lastname: Wilson
authors.affiliation: North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Uniformed Services University of Health Science, Bethesda, MD.
authors.forename: Ramon
authors.initials: R
authors.lastname: Diaz-Arrastia
authors.affiliation: Mayo Clinic Traumatic Brain Injury Model System, Rochester, MN.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bergquist
authors.affiliation: TIRR Memorial Hermann, Houston, TX.
authors.forename: Mark
authors.initials: M
authors.lastname: Sherer
authors.affiliation: Rocky Mountain Regional Brain Injury System, Englewood, CO.
authors.forename: Gale
authors.initials: G
authors.lastname: Whiteneck
authors.affiliation: National Data and Statistical Center/Craig Hospital, Englewood, CO.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pretz
authors.affiliation: James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Vanderploeg
authors.affiliation: North Texas Traumatic Brain Injury Model Systems Center, Dallas, TX; Baylor Institute for Health Care Research and Improvement, Dallas, TX. Electronic address: shahid.shafi@baylorhealth.edu.
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000534:rehabilitation*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Brain injuries; Inpatients; Rehabilitation; Treatment outcome