Journal CME, December 2022: Centering race/ethnicity: Differences in traumatic brain injury inpatient rehabilitation outcomes-Article

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This study investigates racial and ethnic disparities in traumatic brain injury (TBI) rehabilitation outcomes across different demographics within inpatient rehabilitation facilities (IRFs) in the United States from 2005 to 2016. The study sample included 41,847 adults who were primarily non-Hispanic Whites (NHWs), with smaller percentages of Hispanics, non-Hispanic Blacks (NHBs), and non-Hispanic Asians (NHAs).<br /><br />Key findings include that NHBs had the longest hospital stays and scored lower on functional independence measures (FIM) related to motor, cognitive, and total function at admission and discharge compared to NHWs. Hispanic and NHA patients also demonstrated lower admission FIM scores but had comparable discharge scores to NHWs. Interestingly, Hispanic individuals were more likely to be discharged directly to home compared to NHWs.<br /><br />These results underscore the existence of significant racial and ethnic disparities in TBI rehabilitation outcomes, suggesting poorer initial functional status and worse efficiency scores during hospitalization among NHB patients. The data highlights potential systemic issues such as possible biases in clinical assessments and differences in quality and intensity of rehabilitation services received by racial/ethnic minorities.<br /><br />Several factors potentially contribute to these disparities, including cultural differences, language barriers, economic constraints, and inherent biases in healthcare. The social determinants of health and structural racism may impact the quality of care and recovery trajectories for minority groups.<br /><br />The study emphasizes the importance of culturally competent care and the need for targeted interventions to mitigate these disparities. Specific recommendations include increasing access to high-quality TBI care, providing more robust patient and family education, and improving clinician cultural sensitivity to ensure equitable health outcomes.<br /><br />Limitations of the study include its retrospective design and reliance on potentially subjective clinical measures like the FIM instrument, which may introduce bias. Future research is needed to explore these findings further and to develop interventions aimed at reducing disparities in TBI rehabilitation outcomes.

Keywords

racial disparities

ethnic disparities

traumatic brain injury

TBI rehabilitation

inpatient rehabilitation facilities

functional independence measures

systemic issues

culturally competent care

social determinants of health

healthcare biases