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Acute care alternate-level-of-care days due to delayed discharge for traumatic and non-traumatic brain injuries.

https://arctichealth.org/en/permalink/ahliterature114257
Source
Healthc Policy. 2012 May;7(4):41-55
Publication Type
Article
Date
May-2012
Author
Chen Amy
Brandon Zagorski
Vincy Chan
Daria Parsons
Rika Vander Laan
Angela Colantonio
Author Affiliation
Toronto Rehabilitation Institute, UHN, Toronto, ON.
Source
Healthc Policy. 2012 May;7(4):41-55
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Brain diseases
Brain Injuries - epidemiology - therapy
Comorbidity
Female
Health Services Misuse
Humans
Length of Stay - statistics & numerical data
Male
Mental disorders
Ontario
Patient Discharge - statistics & numerical data
Young Adult
Abstract
Alternate-level-of-care (ALC) days represent hospital beds that are taken up by patients who would more appropriately be cared for in other settings. ALC days have been found to be costly and may result in worse functional outcomes, reduced motor skills and longer lengths of stay in rehabilitation. This study examines the factors that are associated with acute care ALC days among patients with acquired brain injury (ABI). We used the Discharge Abstract Database to identify patients with ABI using International Classification of Disease-10 codes. From fiscal years 2007/08 to 2009/10, 17.5% of patients with traumatic and 14% of patients with non-traumatic brain injury had at least one ALC day. Significant predictors include having a psychiatric co-morbidity, increasing age and length of stay in acute care. These findings can inform planning for care of people with ABI in a publicly funded healthcare system.
Notes
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Cites: CMAJ. 1997 Oct 1;157(7):889-969327796
PubMed ID
23634162 View in PubMed
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An examination of discharge against medical advice from brain injury inpatient rehabilitation.

https://arctichealth.org/en/permalink/ahliterature116053
Source
Brain Inj. 2013;27(3):325-31
Publication Type
Article
Date
2013
Author
Hwan Kim
Angela Colantonio
Author Affiliation
Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea.
Source
Brain Inj. 2013;27(3):325-31
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain Injuries - epidemiology - psychology - rehabilitation
Canada - epidemiology
Cohort Studies
Female
Hospitalization - statistics & numerical data
Humans
Length of Stay
Male
Mental Disorders - epidemiology
Middle Aged
Patient Compliance - psychology - statistics & numerical data
Patient Discharge - statistics & numerical data
Referral and Consultation
Rehabilitation Centers - statistics & numerical data
Retrospective Studies
Risk factors
Substance-Related Disorders - epidemiology
Abstract
Discharges against medical advice (DAMA) have been considered predictors of adverse outcomes for patients in acute care and psychiatric hospitals. However, little is known about the profile of patients who discharge AMA admitted to rehabilitation hospitals. The aims of this study were to provide a profile of patients who received inpatient rehabilitation services following a traumatic brain injury (TBI) who discharged AMA and to compare this group with the regular discharge group.
Retrospective cohort study.
Hospital discharge data from two national administrative databases were reviewed for the years 2001-2006.
The databases yielded 1559 cases of TBI (average length of stay?=?51 days). Of these, 31 (2.0%) had recorded DAMA events: one in 50 patients left rehabilitation against medical advice. Compared to regular discharge (n?=?1247), DAMA was significantly associated with unemployment, intentional injury, higher motor functions at admission and shorter length of stay. Known factors for DAMA in acute hospitals, such as male sex, young age and substance abuse history, were not significant.
Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
PubMed ID
23438352 View in PubMed
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Brain injury from a first nations' perspective: teachings from elders and traditional healers.

https://arctichealth.org/en/permalink/ahliterature130010
Source
Can J Occup Ther. 2011 Oct;78(4):237-45
Publication Type
Article
Date
Oct-2011
Author
Michelle L Keightley
Grace E King
Shu-Hyun Jang
Randy J White
Angela Colantonio
J Bruce Minore
Mae V Katt
D Anita Cameron
Alice M Bellavance
Claudine H Longboat-White
Author Affiliation
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto Rehabilitation Institute and Holland Bloorview Kids Rehabilitation Hospital, 160-500 University Ave., Toronto, ON, Canada, M5G 1V7. michelle.keightley@utoronto.ca
Source
Can J Occup Ther. 2011 Oct;78(4):237-45
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Brain Injuries - ethnology - rehabilitation - therapy
Canada
Female
Humans
Indians, North American
Male
Medicine, Traditional
Occupational therapy
Abstract
There is a lack of knowledge about how cultural ideas affect First Nations peoples' perception of rehabilitation needs and the ability to access services.
The study explored the perceptions of treating and healing brain injury from First Nations elders and traditional healers in the communities served by Wassay-Gezhig-Na-Nahn-Dah-We-lgamig (Kenora Area Health Access Centre).
A participatory action approach was used, leading to a focus group with elders and traditional healers. Findings, established through a framework analysis method, were member checked prior to dissemination.
Four themes arose from the data: pervasiveness of spirituality, "fixing" illness or injury versus living with wellness, working together in treating brain injury, and financial support needed for traditional healing.
Funding is required for traditional healing services to provide culturallysafe and responsive occupational therapy services to First Nations individuals with brain injury.
PubMed ID
22043555 View in PubMed
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Characteristics and functional outcomes of brain injury caused by physical assault in Canada: a population-based study from an inpatient rehabilitation setting.

https://arctichealth.org/en/permalink/ahliterature115660
Source
Disabil Rehabil. 2013;35(26):2213-20
Publication Type
Article
Date
2013
Author
Hwan Kim
Mark Bayley
Deirdre Dawson
Tatyana Mollayeva
Angela Colantonio
Author Affiliation
Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University , Gyeongbuk , Republic of Korea .
Source
Disabil Rehabil. 2013;35(26):2213-20
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Brain Injuries - etiology - psychology - rehabilitation
Canada
Female
Humans
Inpatients - psychology - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care)
Patient Discharge - statistics & numerical data
Population Surveillance
Prospective Studies
Recovery of Function
Regression Analysis
Rehabilitation Centers
Risk factors
Sex Factors
Socioeconomic Factors
Abstract
To investigate the characteristics and inpatient rehabilitation outcomes of persons who sustained a traumatic brain injury (TBI) resulting from physical assault - a form of intentional TBI - and compare these outcomes to those of persons with TBI resulting from other aetiologies.
A prospective population-based cohort study using inpatient rehabilitation data from Canadian population-based administrative databases for the fiscal years 2001-2006. Outcome measures were measures of functional independence (motor and cognitive), as measured by the FIMâ„¢ Instrument, and discharge destinations.
Characteristics associated with intentional TBI were being male, younger in age and unemployed; living alone and having a greater likelihood of alcohol/drug abuse prior to admission. The intentional TBI group showed poorer total functional gains at discharge from inpatient rehabilitation. Multivariate regression analyses showed that persons with intentional injury were less likely to be discharged home.
Persons with TBI from physical assault are a distinct clinical group in Canadian inpatient rehabilitation settings. These findings can support clinicians in determining proper assessment, management, discharge planning and post-rehabilitation care that target specific needs of persons with TBI resulting from physical assault.
Clinicians should have appropriate training to properly assess the mental health status of this patient group. Inpatient rehabilitation facilities should be prepared to provide services targeting psychosocial, substance abuse and interpersonal relationship issues to persons with a TBI from physical assault while patients are still within a hospital setting. Follow-up clinical care and community support services are warranted for those with intentional TBIs, including provision of occupational rehabilitation services, such as vocational rehabilitation. The discharge team should be responsible for ensuring appropriate discharge to community in the absence of family or other advocates on behalf of the patient.
PubMed ID
23480674 View in PubMed
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Cognitive impairment predicts fatal incident stroke: findings from a national sample of older adults.

https://arctichealth.org/en/permalink/ahliterature133300
Source
J Am Geriatr Soc. 2011 Aug;59(8):1490-6
Publication Type
Article
Date
Aug-2011
Author
Philippa J Clarke
Vanessa Blount
Angela Colantonio
Author Affiliation
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA. pjclarke@umich.edu
Source
J Am Geriatr Soc. 2011 Aug;59(8):1490-6
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Aged
Aged, 80 and over
Canada
Cognition Disorders - mortality
Cohort Studies
Comorbidity
Diabetes Mellitus - mortality
Disability Evaluation
Female
Geriatric Assessment - statistics & numerical data
Health Surveys
Heart Diseases - mortality
Humans
Hypertension - mortality
Incidence
Longitudinal Studies
Male
Parkinson Disease - mortality
Prospective Studies
Risk
Stroke - mortality
Abstract
To investigate the effect of cognitive impairment on fatal and nonfatal incident stroke in older adults.
A large, national, prospective, population-based study of a representative cohort of older Canadians followed over a 10-year period.
Secondary analyses were conducted using data from the Canadian Study of Health and Aging, a population-based study of older adults followed prospectively from 1991 to 2001.
Nine thousand four hundred fifty-one adults aged 65 and older who had not previously been diagnosed with stroke at baseline (in 1991).
In addition to known risk factors, the independent contribution of cognitive function (diagnosed in a clinical examination) was examined as a risk for stroke in older adults.
Multinomial logistic regression analyses showed that cognitive impairment was associated with twice the odds of fatal incident stroke, controlling for well-established risk factors.
This study provides further evidence for the need to consider cognitive function in relation to stroke risk in older populations.
PubMed ID
21718277 View in PubMed
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Community integration outcomes after traumatic brain injury due to physical assault.

https://arctichealth.org/en/permalink/ahliterature115028
Source
Can J Occup Ther. 2013 Feb;80(1):49-58
Publication Type
Article
Date
Feb-2013
Author
Hwan Kim
Angela Colantonio
Deirdre R Dawson
Mark T Bayley
Author Affiliation
Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University, Jullyang, Gyeongsan, Gyeongbuk, Republic of Korea.
Source
Can J Occup Ther. 2013 Feb;80(1):49-58
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain Injuries - etiology - psychology - rehabilitation
Canada
Family Relations
Female
Humans
Male
Middle Aged
Multivariate Analysis
Questionnaires
Recreation - psychology
Retrospective Studies
Self Concept
Social Participation - psychology
Statistics, nonparametric
Travel - psychology
Violence
Work - psychology
Young Adult
Abstract
Community integration is considered an ultimate goal for rehabilitation after traumatic brain injury (TBI).
To determine (a) whether differences exist in rehabilitation outcomes between intentional and unintentional TBI populations and (b) whether TBI from assault is a predictor of community integration following inpatient rehabilitation.
Retrospective cohort study using population-based data from Canadian hospital administration records, 2001 to 2006. Outcome measure was the Reintegration to Normal Living Index (RNLI).
From a sample of 243 persons, 24 (9.9%) had sustained TBI from physical assault. Persons with TBI from physical assault reported significantly lower scores on two items on the RNLI's Daily Functioning subscale: "recreation" and "family role."
These findings suggest that targeted intervention in these specific areas could be beneficial, which are often primarily addressed by occupational therapists in both inpatient rehabilitation and community settings.
PubMed ID
23550497 View in PubMed
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Differential experiences during the holocaust and suicidal ideation in older adults in treatment for depression.

https://arctichealth.org/en/permalink/ahliterature168717
Source
J Trauma Stress. 2006 Jun;19(3):417-23
Publication Type
Article
Date
Jun-2006
Author
Diana E Clarke
Angela Colantonio
Anne Rhodes
David Conn
Ron Heslegrave
Paul Links
Rob van Reekum
Author Affiliation
University of Toronto and Baycrest Centre for Geriatric Care, Ontario, Canada. dclarke@baycrest.org
Source
J Trauma Stress. 2006 Jun;19(3):417-23
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Aged
Case-Control Studies
Concentration Camps
Cross-Sectional Studies
Depressive Disorder - ethnology - psychology
Female
Holocaust - psychology
Humans
Jews - psychology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Ontario - epidemiology
Retrospective Studies
Risk
Stress Disorders, Post-Traumatic - ethnology - psychology
Suicide - ethnology - psychology
Survivors - psychology
World War II
Abstract
Data were used on 275 Jewish individuals aged 50 and older in outpatient treatment for depression in this retrospective cross-sectional study. Holocaust survivors who were in work camps, in ghettos, or in hiding (HS-WGH) and holocaust survivors who were in concentration camps (HS-CC) were more likely to suffer posttraumatic stress disorder compared to other survivors (HS-OT) and controls. The HS-WGH and HS-CC groups had at least a threefold greater odds of suicidal ideation compared to controls. Suicidal ideation rates did not differ significantly between HS-OT group and controls. Among survivors, HS-WGH had a threefold greater odds of suicidal ideation compared to HS-OT. The results are applicable to survivors of similar atrocities and show that differing types and severities of traumatic experiences have important implications for treatment planning.
PubMed ID
16789004 View in PubMed
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Direct cost associated with acquired brain injury in Ontario.

https://arctichealth.org/en/permalink/ahliterature121520
Source
BMC Neurol. 2012;12:76
Publication Type
Article
Date
2012
Author
Amy Chen
Ksenia Bushmeneva
Brandon Zagorski
Angela Colantonio
Daria Parsons
Walter P Wodchis
Author Affiliation
Toronto Rehabilitation Institute, Toronto, ON, Canada.
Source
BMC Neurol. 2012;12:76
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Ambulatory Care - economics - statistics & numerical data
Brain Injuries - economics - epidemiology
Child
Child, Preschool
Cost of Illness
Female
Health Care Costs - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Middle Aged
Ontario - epidemiology
Prevalence
Risk factors
Sex Distribution
Young Adult
Abstract
Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada.
A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer's perspective.
Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components.
The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
Notes
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Cites: Arch Phys Med Rehabil. 1997 Dec;78(12):1316-209421984
Cites: Eur J Health Econ. 2004 Oct;5 Suppl 1:S84-9115754079
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Cites: Am J Phys Med Rehabil. 2005 Mar;84(3):153-6015725788
PubMed ID
22901094 View in PubMed
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Discharge against medical advice after traumatic brain injury: is intentional injury a predictor?

https://arctichealth.org/en/permalink/ahliterature134206
Source
J Trauma. 2011 Nov;71(5):1219-25
Publication Type
Article
Date
Nov-2011
Author
Hwan Kim
Angela Colantonio
Mark Bayley
Deirdre Dawson
Author Affiliation
Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada. hwan.kim@utoronto.ca
Source
J Trauma. 2011 Nov;71(5):1219-25
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain Injuries - etiology
Chi-Square Distribution
Female
Humans
Injury Severity Score
Length of Stay - statistics & numerical data
Logistic Models
Male
Middle Aged
Ontario
Patient Discharge - statistics & numerical data
Registries
Retrospective Studies
Risk factors
Self-Injurious Behavior
Treatment Refusal - statistics & numerical data
Abstract
Discharge against medical advice (DAMA) have consistently been reported as causing adverse outcomes for both patients and service providers. However, little is known about the DAMA of patients with traumatic brain injury (TBI). The objectives of this study were to develop a risk profile of DAMA patients in the TBI population, to examine factors associated with DAMA occurrence, and to examine specifically whether injury intention (unintentional vs. intentional) is a significant predictor of DAMA.
A retrospective cohort study was conducted using hospital discharge data obtained from the Minimal Data Set (MDS) of the Ontario Trauma Registry for the years 1993/1994 and 2000/2001 on TBI patients aged 15 to 64 years.
The MDS review yielded 15,684 cases of TBI with an average length of stay of 2.7 days. Of these, 446 (2.84%) had recorded DAMA events. When compared with patients with unintentional TBI, DAMA was significantly associated with intentional injuries in those with self-inflicted TBI (adjusted odds ratio [aOR] = 1.97; 95% confidence interval [CI], 1.36-2.84) and other-inflicted TBI (aOR = 2.00; CI, 1.53-2.62). DAMA was also associated with younger age and a history of alcohol/drug abuse (aOR = 3.50; CI, 2.85-4.30).
TBI patients who leave hospital against medical advice are a high-risk population. Early identification of these patients could allow implementation of better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
PubMed ID
21610534 View in PubMed
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Early identification and incidence of mild TBI in Ontario.

https://arctichealth.org/en/permalink/ahliterature149347
Source
Can J Neurol Sci. 2009 Jul;36(4):429-35
Publication Type
Article
Date
Jul-2009
Author
Won Hyung A Ryu
Anthony Feinstein
Angela Colantonio
David L Streiner
Deirdre R Dawson
Author Affiliation
Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, Ontario, Canada.
Source
Can J Neurol Sci. 2009 Jul;36(4):429-35
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adult
Brain Injuries - complications - diagnosis - epidemiology
Cross-Sectional Studies
Early Diagnosis
Emergency Service, Hospital - statistics & numerical data
Female
Glasgow Coma Scale
Humans
Incidence
Male
Medical Records - statistics & numerical data
Middle Aged
Ontario - epidemiology
Primary Health Care
Retrospective Studies
Risk assessment
Statistics, nonparametric
Abstract
(1) To examine the variability in diagnosis of mild traumatic brain injury (mTBI) in primary care relative to that of an expert reviewer; and (2) to determine the incidence rate of mTBI in Ontario, Canada.
Potential mTBI cases were identified through reviewing three months of Emergency Department (ED) and Family Physician (FP) health records. Potential cases were selected from ED records using the International Classification of Disease, 9th revision, Clinical Modification and External Cause codes and from all FPs records for the time period. Documented diagnoses of mTBI were compared to expert reviewer diagnosis. Incidence of mTBI was determined using the documented diagnoses and data from hospital catchment areas and population census.
876 potential mTBI cases were identified, 25 from FP records. Key indicators of mTBI were missing on many records (e.g., 308/876 records had Glasgow Coma Scale (GCS) scores). The expert reviewer disagreed with the documented diagnosis in 380/876 cases (kappa = 0.19). The expert reviewer was more likely to give a diagnosis if the GCS was 13-14, if there was documented loss of consciousness and/or post-traumatic amnesia, and/or if there was pathology found on an acute brain scan. Calculated incidence rates of hospital-treated mTBI were 426 or 535/100,000 (expert review--hospital diagnosis). Including family physician cases increased the rate to 493 or 653/100,000.
Health record documentation of key indicators for mTBI is often lacking. Notwithstanding, some patients with mTBI appear to be missed or misdiagnosed by primary care physicians. A more comprehensive case definition resulted in estimated incidence rates higher than previous reports.
Notes
Comment In: Can J Neurol Sci. 2009 Jul;36(4):405-619650349
PubMed ID
19650352 View in PubMed
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37 records – page 1 of 4.