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 worldwide  Cost 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

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

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)4161 Females3041 Charlson Comorbidity Index Score (2+)1016 Extended LOS627 Living Alone at Admission2336 Living at Home at Admission9776 Required & Received Informal Support8884 Rural Residence189

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)5273 Females4551 Charlson Comorbidity Index Score (2+)4143 Extended LOS819 Living Alone at Admission2043 Living at Home at Admission9878 Required & Received Informal Support8783 Rural Residence1711

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:  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)

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 ) Support for Vincy Chan: CIHR, Ontario Neurotrauma Foundation, Brain Canada, Pediatric Oncology Group of Ontario, CIBC Acknowledgements

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