2025 American Academy of Neurology Abstract Website

Objective:

To determine the relationship of insurance payor to functional status 1-year post-injury in individuals with traumatic brain injury (TBI) following inpatient rehabilitation

Background:

Previous studies have examined the relationship between insurance payor and discharge disposition or TBI outcomes in acute trauma settings. Few have investigated the contribution of insurance to functional improvement following rehabilitation. Insurance is an important social determinant of health than can impact outcomes.

Design/Methods:

Participants were individuals with medically documented complicated mild to severe TBI enrolled in the TBI Model Systems national database, which requires Level One acute trauma care and inpatient TBI rehabilitation. Rehabilitation insurance payor status was classified as charity, private, public, worker’s compensation/auto, or self-pay. Functional status was assessed by the 1 year post-injury Functional Independence Measure (FIM) motor and cognitive domain scores. Contribution of insurance group to 1 year FIM scores were investigated by linear regression, covarying for age and FIM scores at rehabilitation discharge.

Results:

FIM motor and cognitive scores at 1 year were analyzed for 5925 and 7403 patients, respectively. Self or private pay patients had the highest mean FIM motor scores, while publically insured patients had the lowest. Privately insured patients had the highest mean FIM cognitive scores, while publically insured patients had the lowest. After controlling for age and FIM scores at rehabilitation discharge, insurance payor contributed significantly to 1 year FIM motor and cognitive scores. Publically insured and workman’s comp/auto patients had lower scores compared to self-pay.

Conclusions:

Publicly insured patients showed less independent functioning at 1 year, even after controlling for functioning at discharge. These data implicate necessary improvements in healthcare access and insurance policy to ensure health equity for patients with TBI. Further studies are warranted to uncover the mechanisms behind disparate TBI outcomes, including covarying for other social determinants of health and injury characteristics.