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