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