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Factors Associated with Living Setting of Patients at Discharge from Inpatient Rehabilitation after Acquired Brain Injury in Ontario. Vincy Chan, Amy Chen, Brandon Zagorski, Daria Parsons, Angela Colantonio University of Toronto & Toronto Rehabilitation Institute, University Health Network. - PowerPoint PPT Presentation
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Factors Associated with Living Setting of Patients at Discharge from Inpatient
Rehabilitation after Acquired Brain Injury in Ontario
Vincy Chan, Amy Chen, Brandon Zagorski, Daria Parsons, Angela Colantonio
University of Toronto & Toronto Rehabilitation Institute, University Health Network
Background
Acquired Brain Injury (ABI): Includes traumatic and non-traumatic brain injury Damage to brain after birth
Leading cause of death, disability worldwideCost of ABI is considerable
Acquired Brain Injury
Traumatic brain injury (TBI): Results from falls, motor vehicle collisions, struck
by/against an object
Non-traumatic brain injury (nTBI): Includes anoxia, toxic effect of substances, brain
tumours, meningitis, metabolic encephalopathy, vascular insults, encephalitis, and other brain disorder and infections
Background and Significance
Paucity of population based studies of ABI patients examining predictors of living setting at discharge from inpatient rehabilitation as an outcome measure across adult age groups
None in Canadian context that includes all forms of ABI
Specific Aims Identify significant factors associated with living in
residential care after inpatient rehabilitation by type of brain injury (TBI vs. nTBI)
The Andersen Behavioral Model was used to identify significant predisposing, need, and enabling factors
MethodsSample: All patients discharged alive from acute care with
TBI diagnostic code between April 1, 2003 – October 31, 2006 and then admitted to inpatient rehabilitation
Data sources: Discharge Abstract Database (DAD) National Rehabilitation Reporting System (NRS) Mandatory reporting in Ontario = population-based
Discharge Abstract Database
All acute care hospital admissions from over 194 publicly funded hospitals in Ontario, Canada
Demographic and clinical information on all hospital admissions and discharges, including transfers and deaths
National Rehabilitation Reporting System
Clinical outcomes, characteristics of rehabilitation activities
Data from every inpatient rehabilitation bed within acute care or free standing rehab hospitals in Ontario, Canada
Methods
Outcome Measure: Living Setting at Discharge from Inpatient
Rehabilitation Home vs. residential care
Methods
Need, Predisposing, and Enabling Variables: Predisposing
Age, sex, English language Need
Charlson Comorbidity Index, length of stay (LOS) in acute care and in inpatient rehabilitation, total function score from the FIM™ Instrument at discharge, living setting at admission, living arrangement at admission
Enabling Motor vehicle collision, urban vs. rural residence, level
of informal support at discharge
Methods
Statistical analyses: Frequency distributions and measures of
central tendency Stratified by type of brain injury
Bivariate and multivariate logistic regression
Results
Patient Characteristics & Significant Predictors
Traumatic Brain Injury (N=840)Demographic and Clinical
CharacteristicsHome (%)n = 700
Residential Care (%) n = 140
Older Adults (65+ Years) 41 61
Females 30 41
Charlson Comorbidity Index Score (2+)
10 16
Extended LOS 6 27
Living Alone at Admission 23 36
Living at Home at Admission 97 76
Required & Received Informal Support
88 84
Rural Residence 18 9
Traumatic Brain Injury
Statistics Significance: *p<.05, **p<.01, ***p<.001
* Age 35 – 44 Years (OR=0.29)*** 1-point increase in FIM score (OR=0.97)** Required & received informal support at discharge (OR=0.40)
*** Longer total length of stay (OR=3.21)*** Living alone at admission (OR=3.02)* Living in non-home setting at admission (OR=4.55)
Non-Traumatic Brain Injury (N=1,848)Demographic and Clinical
CharacteristicsHome (%)n = 1,527
Residential Care (%) n = 321
Older Adults (65+ Years) 52 73
Females 45 51
Charlson Comorbidity Index Score (2+)
41 43
Extended LOS 8 19
Living Alone at Admission 20 43
Living at Home at Admission 98 78
Required & Received Informal Support
87 83
Rural Residence 17 11
Non-Traumatic Brain Injury
Statistics Significance: *p<.05, **p<.01, ***p<.001
*** 1-point increase in FIM score (OR=0.97)** Required & received informal support at discharge (OR=0.64)* Rural residence (OR=0.60)
* Older adults (OR=3.43)*** Longer total length of stay (OR=2.04)*** Living alone at admission (OR=4.63)*** Living with paid attendant at admission (OR=4.47)* Living in non-home setting at admission (OR=9.43)
Summary
Factors associated with residential care setting after inpatient rehabilitation include:AgeExtended Length of stay (highest quartile)Functional statusLiving Setting at admission (not home)Living Alone/with attendant at admissionLevel of Informal supportRural/urban residence (for NTBI)
Limitations
Extensive validation not done on all variables Good agreement for non-clinical variables,
moderate to substantial agreement for most responsible diagnoses, good specificity of ABI codes
Not all desired variables available Patients not admitted to inpatient rehabilitation
from acute care would be missed
Implications Provides rationale for community support and
improving functional status may reduce institutionalization
Implications for aging population Acute care outcome measures should include
functional outcome
Disclosure: This study funded by the Ontario Neurotrauma Foundation, Toronto Rehabilitation Institute, University Health Network, and the Ontario Ministry of Health and Long-Term Care
Support for Dr. Colantonio:Saunderson Family Chair, Toronto Rehabilitation Institute, Canadian Institutes for Health Research (CIHR) Chair in Gender, Work and Health (#CGW-126580)
Support for Vincy Chan: CIHR, Ontario Neurotrauma Foundation, Brain Canada, Pediatric Oncology Group of Ontario, CIBC
Acknowledgements
Thank You! Merci! For more information:
www.abiresearch.utoronto.ca