Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes.

Document Type

Article

Abstract

INTRODUCTION: Although general physiatry acute-care consultation services are commonplace and improve length of stay (LOS), the benefits of a subspecialty physiatric continuity consultation service targeting patients with severe brain injury have not been reported.

OBJECTIVES: Our primary objective was to characterize patient care recommendations from a Brain Injury Medicine (BIM) Continuity Consult Service, and to investigate the effects on acute-care LOS relative to brain injury patients receiving General Physical Medicine & Rehabilitation (PM&R) Consult Services. Our secondary objectives were to examine inpatient rehabilitation (IPR) health care utilization metrics and costs between groups and evaluate clinical improvements during IPR and discharge disposition.

DESIGN: Retrospective cohort comparison study.

SETTING: Academic medical center with level 1 trauma center.

PARTICIPANTS: Adults with severe brain injury admitted to a single-site acute-care facility and subsequently admitted to a single inpatient brain injury rehabilitation unit over the same time period.

PHYSIATRIC CARE MODELS: BIM Continuity Consult Service versus General PM&R Consult Service.

MAIN OUTCOME MEASURES: Acute-care LOS; unplanned discharges to acute-care.

RESULTS: Despite no major demographic or clinical group differences, the BIM Consult Service had more patient comorbidities than General PM&R Consult Service (17.5±5.3 versus 16±5.1;P = .04). BIM Consult Service patients spent fewer days in acute care (30±11.8 versus 36±22.8; P = .008), and early BIM consult (≤7 days after admission) was associated with shorter acute-care LOS (P < .002). IPR LOS was similar between groups when considering unplanned transfers. Unplanned transfers among General PM&R Consult Service patients occurred twice as frequently as in BIM Consult Service patients; average readmission costs were $2778 per patient on the BIM Consult Service and $6702 per patient on the General PM&R Consult Service. More BIM Consult Service (85.7%) than General PM&R Consult Service (27.3%) patients emerged from disorders of consciousness during IPR (P = .02).

CONCLUSIONS: BIM Continuity Consultation Services were associated with shorter acute-care LOS, fewer unplanned acute-care transfers, and an increased likelihood of emerging from a minimally conscious state during IPR.

Medical Subject Headings

Adult; Brain Injuries; Humans; Length of Stay; Patient Acceptance of Health Care; Referral and Consultation; Retrospective Studies; Treatment Outcome

Publication Date

11-1-2021

Publication Title

PM R

ISSN

1934-1563

Volume

13

Issue

11

First Page

1227

Last Page

1236

PubMed ID

33527710

Digital Object Identifier (DOI)

10.1002/pmrj.12563

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