Impact of Racial-Ethnic Minority Status and Systemic Vulnerabilities on Time to Acute TBI Rehabilitation Admission in an Urban Public Hospital Setting

• Published in: Rehabilitation psychology 2019-05, Vol.64 (2), p.229-236
• Main Authors: Fuentes, Armando, Schoen, Chelsea, Kulzer, Rebecca R, Long, Coralynn, Bushnik, Tamara, Rath, Joseph F
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brain Injuries, Traumatic - rehabilitation; Cognitive Rehabilitation; Continental Population Groups - statistics & numerical data; Ethnic Groups - statistics & numerical data; Female; Health Disparities; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Hospital Admission; Hospitalization - statistics & numerical data; Hospitals, Public; Hospitals, Urban; Human; Humans; Inpatient; Insurance Coverage; Male; Middle Aged; Minority Groups; Minority Groups - statistics & numerical data; Racial and Ethnic Groups; Rehabilitation; Time Factors; Traumatic Brain Injury; Young Adult
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000260

Purpose/Objective: Racial/ethnic minorities and other vulnerable social groups experience health care disparities. There is a lack of research exploring how time to acute rehabilitation admission is impacted by race/ethnicity and other marginalizing systemic vulnerabilities. The purpose of this study is to investigate whether race/ethnicity and other sociodemographic vulnerabilities impact expediency of acute rehabilitation admission following traumatic brain injury (TBI). Research Method/Design: This study is a secondary analysis of an existing dataset of 111 patients admitted for acute TBI rehabilitation at an urban public hospital. Patient groups were defined by race/ethnicity (People of color or White) and vulnerable group status (high or low vulnerable group membership [VGM]). Results: White patients are admitted to acute TBI rehabilitation significantly faster than people of color. After taking vulnerabilities into account, high VGM people of color experience the most severe injuries and take the longest to receive acute TBI rehabilitation. Despite small differences in injury severity, low VGM people of color take longer to be admitted to acute TBI rehabilitation than White patients. High VGM White patients have less severe injuries yet take longer to be admitted to acute rehabilitation than low VGM White patients. Finally, notable differences exist between White patients and patients of color on rater-based injury severity scales that are discordant with severity as measured by more objective markers. Conclusions/Implications: Overall, findings indicate that sociodemographic factors including race/ethnicity and systemic vulnerabilities impact injury severity and time to acute TBI rehabilitation admission. Impact and Implications Although racial/ethnic minorities experience health care disparities following TBI, research on the combined effects of race/ethnicity with other marginalized identities has been neglected. This study is the first to demonstrate the impact of race/ethnicity and other systematic barriers on time to acute rehabilitation admission following TBI. This study confirms that even in a diverse, metropolitan public hospital, people of color wait longer to receive acute rehabilitation services following TBI. Culturally appropriate educational information regarding brain injury, as well as increased provider awareness of unconscious biases that inform clinical decision making, should underpin policy development and service delivery to e