Impact of implementing a specialized rehabilitation hospital system on healthcare utilization in patients with traumatic brain injury: a nationwide retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective Before 2019, the Republic of Korea lacked a coordinated rehabilitation healthcare delivery system, which resulted 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 is sparse. Therefore, this study evaluated 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 the Republic of Korea. 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 not admitted to a specialized rehabilitation hospital within 90 days of TBI onset. Propensity score weighting using the average treatment effect on the treated (ATT) was applied to improve comparability between the groups, followed by a difference-in-differences (DID) analysis of length of stay (LOS). Logistic regression was performed to identify factors associated with admission to a specialized rehabilitation hospital. Healthcare utilization pathways involving specialized rehabilitation hospitals and long-term care hospitals (LTCHs) within 90 days of TBI onset were evaluated. Results The ATT-weighted DID analysis showed a significant 10.0% increase in LOS following implementation of the specialized rehabilitation hospital system (95% confidence interval [CI], 0.3–20.6; p = 0.043). The odds of admission to a specialized rehabilitation hospital were significantly higher in the post-implementation period than in the pre-implementation period (OR, 1.36; 95% CI, 1.18–1.55; p < 0.001). The proportion of patients who utilized a specialized rehabilitation hospital first increased from 4.0% to 7.2%, with significantly higher relative odds in the post-implementation period (OR, 2.00; 95% CI, 1.61–2.49; p < 0.001). Conclusions Implementation of the specialized rehabilitation hospital system was associated with increased healthcare utilization and changes in post-acute healthcare utilization pathways among patients with TBI. These findings provide evidence regarding changes in healthcare utilization following implementation of the system.
Institutions: National Health Insurance Service, Yonsei University
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,353
OpenAlex ID: W7154898390