1. Factors Associated with Receiving Chaplaincy Care: - Findings from a Study of Patients with TBI
George Fitchett, D.Min., Ph.D.
Department of Religion, Health & Human Values
James Risk, MDiv, BCC
Executive Director (retired)
Bishop Anderson House
Hendrik Hutagaol, MA, BCC
Chaplain
Loma Linda University Medical Center

2. Framing our Research Sneak Preview Study Methods Study Findings
Outline
Framing our Research
Sneak Preview
Study Methods
Study Findings
Discussion
Future Research
form rehab research collaborative

3. No conflicts to declare
Objectives
At the conclusion of this activity:
Participants will be able to critically reflect on the factors that shape which patients receive spiritual care and how much care they receive.
Participants will be able to critically describe an instrument that was developed to collect data about the type and amount of chaplain care in 3 different institutions.
Participants will be able to describe what is required to develop objective indicators for spiritual care in diverse clinical contexts, including acute rehabilitation.
No conflicts to declare

4. Framing Our Research
What information do you have, would you like to have, to answer these questions?
1. You are a spiritual care department manager. Your institution is about to acquire a 35 bed medical rehabilitation facility that has had no spiritual care. Your administrator asks you what level of chaplaincy staffing will be needed. What do you tell her?

5. Framing Our Research
What information do you have, would you like to have, to answer these questions?
2. A new director of OT has come to your acute rehab unit and wants you to do an in-service on when OTs should make referrals to the chaplain. What do you tell them?

6. Framing Our Research
What information do you have, would you like to have, to answer these questions?
3. You are the chaplain for your 25-bed acute medical rehab unit. You also cover 3 general med/surg units with a total of 90 beds. How do you decide which patients to see in each of these areas?

7. Sneak Preview – What We Found
There was wide variation, across the 3 institutions in:
percent of patients who received any chaplain care and,
among those who received any chaplain care, the amount of chaplain care they received.
Essentially none of the variables we tested (demographic, medical, psychological, religious) were consistent predictors of receiving any chaplain care or of the amount of chaplain care received.

8. in Acute Rehabilitation for TBI Using Practice-Based Evidence (PBE)
Parent Study
Improving Outcomes
in Acute Rehabilitation for TBI
Using Practice-Based Evidence (PBE)
Susan Horn, PhD, PI,
International Severity Information Systems, Salt Lake City
(presently University of Utah School of Medicine)
John D. Corrigan, PhD, Co-PI
Ohio State University
PBE is an alternative to RCTs for determining effectiveness of interventions.

9. Parent Study: Aims
Aim 1: Identify patient characteristics (demographic, medical) that explain variation in the outcomes of acute rehabilitation for TBI.
Aim 2: Identify specific procedures and interventions that are associated with better outcomes, controlling for patient characteristics.
Aim 3: Determine whether specific impairment-by-treatment interactions are associated with better outcomes.
TBI Mtg Overview and Design 11/5-6/07

10. Parent Study: Method Study Variables Patient characteristic variables
Severity of the TBI and other medical conditions, demographics and psychosocial background
Process variables
All rehabilitation interventions (therapy, medical interventions, patient education, counseling, and activities involving all disciplines)
Outcome variables
Functional independence, length of stay, and discharge location
Data Sources:
Medical record
Patient characteristics and medical procedures
Point-of-care documentation

11. Multi-Center Study Rush University Medical Center Chicago, IL
Loma Linda University Rehabilitation Institute
Loma Linda, CA
Toronto Rehabilitation Institute
Toronto, ON, Canada
Wexner Medical Center
Columbus, OH
Carolinas Rehabilitation, Carolinas HealthCare System
Charlotte, NC
Mount Sinai Medical Center
New York, NY
National Rehabilitation Hospital
Washington, DC
Shepherd Center
Atlanta, GA
Intermountain Medical Center
Salt Lake City, UT
Brooks Rehabilitation Hospital
Jacksonville, FL
N=2130 patients enrolled from October 2008 to September 2011
TBI Mtg Overview and Design 11/5-6/07

12. Chaplain Sub-Study: Aims
Aim 1. To describe the spiritual care provided by the chaplains to the TBI patients in this study.
Our goal in this aim was to describe the type and extent of the chaplains’ spiritual care for these patients and to explore a number of factors that might be associated with variations in the care that was provided.
Aim 2. To examine the effect of chaplain care on patient outcomes.
TBI Mtg Overview and Design 11/5-6/07

13. Chaplain POC Form

14. Chaplain POC Form

15. Study Participants Variable LLU (n = 112) RMC (n = 71) TRI (n = 149)
Age - mean (range)*
39.8 (14-88)
67.6 (22-90)
48.1 (19-88)
Gender: Female
30%
28%
Race White*
48%
51%
71%
Race Black 9%
41% 6%
Race White Hispanic
38% 4% 0%
Race Asian/Other/Unknown 5%
24%
Marital Status Single (Never married)*
46%
11%
34%
Marital Status Married/Common Law
36%
39%
44%
Marital Status Previously married
13%
16%
Marital Status Other/Unknown
Education HS or less*
67%
59%
Education More than HS
37%
Education Unknown
Employment Employed + Student* 7%
Employment Employed only
49%
14%
Employment Not Employed
23%
Employment Retired
18%
63%
25%
Employment Student only
Employment Unknown 3%
English is Primary Language
92%
86%
83%
*significant differences between centers

16. Study Participants Variable LLU (n = 112) RMC (n = 71) TRI (n = 149)
Injury Cause Fall*
18%
85%
42%
Injury Cause Vehicle
66% 7%
46%
Injury Cause Misc 4% 6% 2%
Injury Cause Sports 5% 0% 1%
Injury Cause Violence 8% 3% 9%
Days injury to rehab admission*
27 (32.1)
11.6 (8.3)
64.8 (47.4)
Admission brain injury CSI*
36.7 (16.2)
36.8 (16.1)
20.5 (12.4)
Admission non-brain injury CSI*
18.5 (12.2)
19.0 (14.3)
4.2 (6.2)
Admission adjusted FIM cognitive*
38.3 (16.7)
41.6 (17.1)
54.3 (11.3)
Admission adjusted FIM motor*
33.9 (11.6)
35.6 (15.0)
62.8 (16.7)
Admission anxiety
10%
Admission depression*
11%
24%
12%
Rehab length of stay*
22.3 (10.5)
15.9 (7.8)
46.1 (22.8)
*significant differences between centers
CSI=comprehensive severity index; FIM=function independence measure

17. Study Participants Variable LLU (n = 112) RMC (n = 71) TRI (n = 149)
Faith Group: Catholic*
21%
28% 8%
Faith Group: Protestant
39%
35% 7%
Faith Group: Other 6% 4%
10%
Faith Group: None/Atheist 9% 5%
Faith Group: Missing
27%
24%
70%
Deeply Religious or Spiritual*a
36%
34%
16%
Fairly Religious or Spiritual
19%
40%
Not at All Religious or Spiritual
25%
How R/S missing or unable to determine
38%
High R/S Distress*a
15% 0%
14%
Moderate R/S Distress
Slight or No R/S Distress
52%
R/S Distress missing or unable to determine
37%
42%
*significant differences between centers
apercent for those with chaplain care

18. Who Receives Chaplain Care
Total
LLU
RMC
TRI
Total patients in study
332
112 71
149
Patientsa with any chaplain care
58%
60%
90%
42%
For patients who received any chaplain care (median + range)
Number of chaplain visits per patient
4 (1-17)
4 (1-11)
3 (1-12)
Total minutes of chaplain care per patient
100 (1-793)
125 (4-455)
63 (1-256)
83 (5-793)
Minutes of chaplain care/week of rehab
28.7
( )
42.0
( )
31.7
( )
13.5
( )
Minutes of OT/week of rehab
(105.25)
307.6 (95.3)
309.0 (91.9)
248.7 (109.6)
Minutes of PT/week of rehab
(120.13)
364.6 (78.9)
357.3 (81.6)
226.9 (119.9)
aIncludes cases with any care to patient, family or both
What questions do you have when you see these data?
Why do some patients get any spiritual care and others get none?
Why do some patients get a lot of spiritual care and others get a little?
There was no association between demographic factors, measures of severity of illness or measures of religion and chaplain care

19. Received Any Chaplain Care
LLU (n=112)
TRI (n=149)
(yes=67, no=45)
(yes=63, no=86)
Variable
OR (95% CI)
p-value
Age
1.02 (0.99,1.04)
0.16
1.0 (0.98,1.02)
0.95
Male (vs Female)
0.39 (0.15,1.03)
0.06
3.11 (1.35,7.16)
0.01
Days Injury to Rehab Admit
1.03 (1,1.06)
0.05
1.0 (0.99,1.01)
0.63
Adm Brain Injury CSI
1.05 (1,1.1)
0.03
1.0 (0.95,1.05)
0.91
Adm Non-Brain Injury CSI
1.03 (0.99,1.07)
0.11
0.99 (0.93,1.05)
0.66
Adm adjusted FIM Cognitive
1.04 (1,1.09)
1.02 (0.96,1.07)
0.55
Adm adjusted FIM Motor
1.03 (0.97,1.08)
0.36
0.99 (0.97,1.02)
0.72
Rehab Length of Stay
1.03 (0.98,1.1)
0.25
0.87
Rush omitted because there was little variation to explain; 90% of patients received some chaplain care.
Models adjusted for all variables listed

20. Minutes of Care Received
Total Sample (n = 180)
Variable
Estimate SE
p-value
Age
-0.145
0.115
0.21
Gender: Male
-7.512
5.354
0.16
Education More than HSa
2.862
5.126
0.58
Education unknowna
-6.782
8.940
0.45
Days injury to rehab admit
-0.089
0.060
0.14
Adm non-brain injury CSI
-0.074
0.202
0.72
Adm adjusted FIM cognitive
0.19
0.198
0.34
Adm adjusted FIM motor
-0.401
0.173
0.02
Fairly Religious or Spiritualb
-3.465
6.378
0.59
Not at All Religious or Spiritualb
7.545
0.07
Unable to determine how R/Sb
11.175
0.12
High Level of R/S Distressc
7.886
8.210
Moderate Level of R/S Distressc
-0.86
6.475
0.90
Unable to Determine Level of R/S Distressc
-4.832
10.716
0.65
R2 = , Adj R2 =
aReference Group = Education Less than HS
bReference group = Deeply Religious or Spiritual
cReference Group = No R/S Distress

21. What about the variations in chaplain care?
Discussion
What about the variations in chaplain care?
2. What about no variables consistently
predicting chaplain care?
3. Limitations
Possible unmeasured predictors of chaplain care
Other limitations

22. Advancing EB Screening & Assessment
Research about spiritual needs can inform the development of EB models for screening and referrals for spiritual care
This will increase the likelihood that patients who need spiritual care are offered the opportunity to receive it
Form a rehab research collaborative?

23. Acknowledgments Parent study funding: NIH Chaplain sub-study funding:
Bishop Anderson House
Susan Horn, PhD (PI parent study), University of Utah School of Medicine
Erin Emery-Tiburcio, PhD, Rush Medical Center
Jim Huth, PhD, BCC, Sunnybrook Veterans Centre, Toronto

24. Bibliography
Archives of Physical Medicine and Rehabilitation
Vol 96, No 8, August 2015, Supplement 3 (special issue of reports on the parent study)
Horn SD, Corrigan JD, Bogner J, Hammond FM, Seel RT, Smout RJ, Barrett RS, Dijkers MP, Whiteneck GG. Traumatic Brain Injury-Practice Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes. Arch Phys Med Rehabil Aug;96(8 Suppl):S e15.