Cluster analysis of vulnerable groups in acute traumatic brain injury rehabilitation

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J79857

Journal:

Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

2018 , 99, 11, 2365-2369

Publication Website:

Abstract:

Study examined the membership of patients with traumatic brain injury (TBI) in various “vulnerable group” clusters (e.g., homeless, unemployed, racial/ethnic minority) by using statistically robust clusters obtained from patient-level data obtained from inpatient visits. Data were obtained from 148 adult patients receiving acute TBI inpatient care. Demographic and psychosocial information, length of hospital stay (acute only), and the Functional Independence Measure (FIM) score change from admission to discharge were compared. The cluster analysis revealed 4 major clusters (A through D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores. Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various “at-risk” groups. The results identified patients who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (e.g., duration of stay) or clinical service improvements (e.g., staff’s language skills, ability to offer substance abuse therapy, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings.

Author(s):