Discharge disposition from acute care after traumatic brain injury: The effect of insurance type

Objective: To determine if persons with traumatic brain injury (TBI) who ar e insured by Medicaid or health maintenance organizations (HMOs) are more l ikely to receive postacute care in skilled nursing facilities (SNFs) than i n rehabilitation facilities, compared with persons insured by commercial fe e-for-service (FFS) plans. Design: Retrospective cohort study. Setting: County hospital admitting 30% of all Washington State TBI patients . Patients: 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. Interventions: Not applicable. Main Outcome Measures: Disposition on discharge from acute care (rehabilita tion facilities vs SNF); adjusted relative risk (RR) and confidence interva l (CI) for different insurance types. Results: After accounting for confounding factors, Medicaid patients were 6 8% 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. Ho wever, the latter difference was not statistically significant. Conclusions: An association exists between insurance type and postacute car e site. Efforts should be made to determine the effect this relationship ha s on the cost and outcomes for TBI patients.