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


Need


Age, sex, English language
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 Characteristics
Home (%)
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
* 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)
Statistics Significance: *p<.05, **p<.01, ***p<.001
Non-Traumatic Brain Injury (N=1,848)
Demographic and Clinical Characteristics
Home (%)
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
*** 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)
Statistics Significance: *p<.05, **p<.01, ***p<.001
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
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
Thank You! Merci!

For more information: www.abiresearch.utoronto.ca