Impact of implementing a specialized rehabilitation hospital system on healthcare utilization in patients with traumatic brain injury: a nationwide retrospective cohort study

Background Before 2019, Korea lacked a coordinated rehabilitation healthcare delivery system, resulting in limited access to intensive rehabilitation during the subacute stage. To overcome this limitation, a specialized rehabilitation hospital system was implemented in 2020, whereby hospitals meeting predefined criteria were designated to provide intensive subacute rehabilitation. However, evidence regarding the effectiveness of the specialized rehabilitation hospital system remains limited. Therefore, this study aimed to evaluate changes in healthcare utilization for inpatient rehabilitation among patients with traumatic brain injury (TBI) before and after the implementation of the specialized rehabilitation hospital system. Methods This study used data from the National Health Insurance Service–Nationwide Health Insurance Database of Korea. To assess the impact of the system, patients were categorized into two groups: the case group, consisting of those admitted to a specialized rehabilitation hospital within 90 days of TBI onset, and the control group, consisting of those with no history of admission to a specialized rehabilitation hospital. To evaluate the effect of the system, a difference-in-differences approach was applied. Logistic regression analysis was performed to identify factors associated with admission to a specialized rehabilitation hospital. Results Length of stay (LOS) increased by 1.0% after the implementation (95% confidence interval [CI], − 20.6 to 28.4), but the change was not statistically significant. Compared with the pre-implementation period, the odds ratio (OR) of admission to a specialized rehabilitation hospital was significantly higher in the post-implementation period (OR, 1.82; 95% CI, 1.49–2.24; p < 0.001). In the case group, most patients (89.9%) were transferred to a specialized rehabilitation hospital as the first healthcare institution after discharge from the index hospital. Conclusions We found that the OR for admission to specialized rehabilitation hospitals were higher in the post-implementation period than in the pre-implementation period. These findings suggest the need to expand the number of specialized rehabilitation hospitals to increase their utilization.