Daria Parsons

Direct cost associated with acquired brain injury in Ontario.

BackgroundAcquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada.MethodsA population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer’s perspective.ResultsDirect medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being

Factors associated with discharge destination from acute care after acquired brain injury in Ontario, Canada

32132 and

Older adults with acquired brain injury: a population based study

38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately

Older Adults with Acquired Brain Injury: Outcomes After Inpatient Rehabilitation

120.7 million for TBI and

Developing quality of care indicators for patients with traumatic and non-traumatic spinal cord injury (SCI): A feasibility study using administrative health data

368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components.ConclusionsThe main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.

Factors associated with living setting at discharge from inpatient rehabilitation after acquired brain injury in Ontario, Canada.

BackgroundThe aim of this paper is to examine factors associated with discharge destination after acquired brain injury in a publicly insured population using the Anderson Behavioral Model as a framework.MethodsWe utilized a retrospective cohort design. Inpatient data from provincial acute care records from fiscal years 2003/4 to 2006/7 with a diagnostic code of traumatic brain injury (TBI) and non-traumatic brain injury (nTBI) in Ontario, Canada were obtained for the study. Using multinomial logistic regression models, we examined predisposing, need and enabling factors from inpatient records in relation to major discharge outcomes such as discharge to home, inpatient rehabilitation and other institutionalized care.ResultsMultinomial logistic regression revealed that need factors were strongly correlated with discharge destinations overall. Higher scores on the Charlson Comorbidity Index were associated with discharge to other institutionalized care in the nTBI population. Length of stay and special care days were identified as markers for severity and were both strongly positively correlated with discharge to other institutionalized care and inpatient rehabilitation, compared to discharge home, in both nTBI and TBI populations. Injury by motor vehicle collisions was found to be positively correlated with discharge to inpatient rehabilitation and other institutionalized care for patients with TBI. Controlling for need factors, rural location was associated with discharge to home versus inpatient rehabilitation.ConclusionsThese findings show that need factors (Charlson Comorbidity Index, length of stay, and number of special care days) are most significant in terms of discharge destination. However, there is evidence that other factors such as rural location and access to supplemental insurance (e.g., through motor vehicle insurance) may influence discharge destination outcomes as well. These findings should be considered in creating more equitable access to healthcare services across the continuum of care.

Systems analysis of community and health services for acquired brain injury in Ontario, Canada

BackgroundAcquired brain injury (ABI), which includes traumatic (TBI) and non-traumatic brain injury (nTBI), is a leading cause of death and disability worldwide. The objective of this study was to examine the trends, characteristics, cause of brain injury, and discharge destination of hospitalized older adults aged 65 years and older with an ABI diagnosis in a population with universal access to hospital care. The profile of characteristics of patients with TBI and nTBI causes of injury was also compared.MethodsA population based retrospective cohort study design with healthcare administrative databases was used. Data on acute care admissions were obtained from the Discharge Abstract Database and patients were identified using the International Classification of Diseases – Version 10 codes for Ontario, Canada from April 1, 2003 to March 31, 2010. Older adults were examined in three age groups – 65 to 74, 75 to 84, and 85+ years.ResultsFrom 2003/04 to 2009/10, there were 14,518 episodes of acute care associated with a TBI code and 51, 233 episodes with a nTBI code. Overall, the rate of hospitalized TBI and nTBI episodes increased with older age groups. From 2007/08 to 2009/10, the percentage of patients that stayed in acute care for 12 days or more and the percentage of patients with delayed discharge from acute care increased with age. The most common cause of TBI was falls while the most common type of nTBI was brain tumours. The percentage of patients discharged to long term care and complex continuing care increased with age and the percentage discharged home decreased with age. In-hospital mortality also increased with age. Older adults with TBI and nTBI differed significantly in demographic and clinical characteristics and discharge destination from acute care.ConclusionsThis study showed an increased rate of acute care admissions for both TBI and nTBI with age. It also provided additional support for falls prevention strategies to prevent injury leading to cognitive disability with costly human and economic consequences. Implications for increased numbers of people with ABI are discussed.

The utility of administrative data for neurotrauma surveillance and prevention in Ontario, Canada

Cette étude a examiné un profil basé sur la population des personnes âgées atteintes des lésions cérébrales acquises (LCA), et de leur résultats fonctionnels, en réadaptation en milieu hospitalier au Canada. Les personnes âgées de 65 ans et plus qui ont été admises en réadaptation en milieu hospitalier de soins aigus pour un traumatisme cranio-cérébrale (TCC) (n = 1 214) ou une lésion cérébrale non pas traumatique (nTCC) (n = 1 530) ont été identifiées en Ontario de 2003/04 à 2009/10. Les caractéristiques démographiques et cliniques et les notes fonctionnelles totales de l’instrument (FIM MD) ont eté examinées. On a utilisé le Base de données sur les congés des patients (BDCP) et le Système nationale d’information sur la réadaptation (SNIR). Les résultats ont montré que les personnes plus âgées atteintes d’un traumatisme cranio-cérébrale (TCC) présentaient un niveau d’indépendence fonctionelle plus élevé que celles sans TCC à l’admission et à la sortie. Cependant, les deux groupes ont faits des gains importants (p = .001) et similaires (p > .05). Nous concluons que les personnes âgées avec TCC et nTCC font des gains similaires de réadaptation en milieu hospitalier. L’incapacité fonctionnelle initiale plus faible des patients nTCC à l’admission et les profils cliniques différents offrent des implications pour la répartition des soins et des ressources cliniques.

Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice

Abstract Objectives (1) to inform the development of health system quality indicators for traumatic and non-traumatic spinal cord injury from acute care admission to community care discharge using administrative data, and (2) to examine characteristics and differences in care among type of care facility, and type of pathology using administrative data. Design Retrospective cohort study using administrative health data. Setting Ontario, Canada. Participants Using administrative health data, we used International Classification codes 10th version Canadian Edition to identify incident cases of SCI from April 1, 2006 to March 31, 2012. Results We identified 7,693 cases in our cohort, of whom 1,537 (20.0%) were categorized as traumatic spinal cord (TSCI) and 6,156 (80.0%) as non-traumatic (NTSCI). Of those identified with NTSCI, more than half (54.0%) were diagnosed with either Guillain Barré syndrome and Multiple Sclerosis (n = 3,326). More individuals admitted to a trauma/spine center were seen by an orthopedic surgeon or a neurosurgeon (20.3% compared to 5.6% for NTSCI; 77.7% compared to 24.9% for TSCI). Only 25.7% (n = 724) of the NTSCI cohort were admitted to a rehabilitation facility from a trauma/spine center, compared to 58.9% (n = 754) of those with TSCI. Conclusions Important challenges in data completeness and utility were identified. Province wide processes to flag incomplete data and provision of incentives for comprehensive data are urgently needed to develop quality indicators across the care continuum. Consensus on the coding for NTSCI for the purposes of developing health system indicators is required.

Who Goes to Residential Care after Inpatient Rehabilitation with Acquired Brain Injury

OBJECTIVE This study examined factors associated with living setting of patients with acquired brain injury at discharge from inpatient rehabilitation. DESIGN Retrospective cohort design. SUBJECTS/PATIENTS Cohort of patients first identified in acute care with a diagnostic code of traumatic or non-traumatic brain injury who also subsequently received inpatient rehabilitation in Ontario, Canada for fiscal years 2003/2004 to 2005/2006. METHODS Using logistic regression, we examined predisposing, need and enabling factors associated with living settings at discharge from inpatient rehabilitation (home/other versus residential care). Acute care and inpatient rehabilitation data were used. RESULTS The majority of patients (83%) were discharged home after inpatient rehabilitation. Among ABI patients, those with longer lengths of stay and patients living alone and in non-home settings at admission were significantly more likely to be living in a residential care setting at discharge. Conversely, patients with higher total function scores from the FIMTM Instrument and those receiving informal support at discharge were significantly less likely to be living in a residential care setting at discharge. CONCLUSION Our findings suggest that informal support influences service utilization and provide evidence for its importance at discharge with respect to living in the community. Prior living arrangement and functional outcome at discharge significantly predicted discharge destination. Improving physical function and providing needed supports at discharge may be factors important to reduce the demand for residential care facilities.