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Vincy Chan, Amy Chen, Brandon Zagorski, Daria Parsons, Angela Colantonio

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.

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Vincy Chan, Amy Chen, Brandon Zagorski, Daria Parsons, Angela Colantonio

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  1. 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

  2. Background Acquired Brain Injury (ABI): Includes traumatic and non-traumatic brain injury Damage to brain after birth Leading cause of death, disability worldwide Cost of ABI is considerable

  3. 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

  4. 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

  5. Specific Aims • Identifysignificant factors associated with living in residential careafter inpatient rehabilitation by type of brain injury (TBI vs. nTBI) • TheAndersen Behavioral Model was used to identify significant predisposing, need, and enabling factors

  6. Methods Sample: • 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

  7. 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

  8. 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

  9. Methods Outcome Measure: • Living Setting at Discharge from Inpatient Rehabilitation • Home vs. residential care

  10. 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

  11. Methods Statistical analyses: • Frequency distributions and measures of central tendency • Stratified by type of brain injury • Bivariate and multivariate logistic regression

  12. Results Patient Characteristics & Significant Predictors

  13. Traumatic Brain Injury (N=840)

  14. Traumatic Brain Injury Statistics Significance: *p<.05, **p<.01, ***p<.001

  15. Non-Traumatic Brain Injury (N=1,848)

  16. Non-Traumatic Brain Injury Statistics Significance: *p<.05, **p<.01, ***p<.001

  17. Summary Factors associated with residential care setting after inpatient rehabilitation include: • Age • Extended Length of stay (highest quartile) • Functional status • Living Setting at admission (not home) • Living Alone/with attendant at admission • Level of Informal support • Rural/urban residence (for NTBI)

  18. 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

  19. Implications • Provides rationale for community supportandimproving functional status may reduce institutionalization • Implications for aging population • Acute care outcome measures should include functional outcome

  20. Acknowledgements 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

  21. Thank You! Merci! • For more information: www.abiresearch.utoronto.ca

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