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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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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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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
Cites: J Head Trauma Rehabil. 2004 Sep-Oct;19(5):405-1215597031
Cites: Arch Phys Med Rehabil. 1997 Dec;78(12):1316-209421984
Cites: Eur J Health Econ. 2004 Oct;5 Suppl 1:S84-9115754079
Cites: Eur J Neurol. 2005 Jun;12 Suppl 1:1-2715877774
Cites: BMJ. 2005 Dec 17;331(7530):1419-2016356951
Cites: Brain Inj. 2008 Jun;22(6):437-4918465385
Cites: Med Care. 2008 Aug;46(8):882-718665069
Cites: Public Health Rep. 2009 Jul-Aug;124(4):551-6019618792
Cites: CMAJ. 2009 Nov 10;181(10):668-919805502
Cites: BJU Int. 2010 Feb;105(3):338-4619594734
Cites: Can J Gastroenterol. 2010 Dec;24(12):717-2621165379
Cites: BMC Neurol. 2011;11:4621496356
Cites: BMC Neurol. 2012;12:1622443681
Cites: BMJ. 2000 Jun 17;320(7250):1631-510856063
Cites: Lancet. 2000 Sep 9;356(9233):923-911036909
Cites: J Head Trauma Rehabil. 2000 Dec;15(6):1208-2611056404
Cites: J Trauma. 2002 Dec;53(6):1152-912478043
Cites: Arch Phys Med Rehabil. 2003 Mar;84(3 Suppl 1):S3-712708551
Cites: J Head Trauma Rehabil. 2004 May-Jun;19(3):217-2515247844
Cites: Am J Public Health. 1984 Jul;74(7):710-26742257
Cites: Can J Surg. 1988 May;31(3):191-43365618
Cites: J Trauma. 1988 Dec;28(12):1637-433199464
Cites: J Trauma. 1996 Feb;40(2):211-78637068
Cites: Brain Inj. 1996 Nov;10(11):841-88905161
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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The effect of traumatic brain injury on the health of homeless people.

https://arctichealth.org/en/permalink/ahliterature154869
Source
CMAJ. 2008 Oct 7;179(8):779-84
Publication Type
Article
Date
Oct-7-2008
Author
Stephen W Hwang
Angela Colantonio
Shirley Chiu
George Tolomiczenko
Alex Kiss
Laura Cowan
Donald A Redelmeier
Wendy Levinson
Author Affiliation
Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. hwangs@smh.toronto.on.ca
Source
CMAJ. 2008 Oct 7;179(8):779-84
Date
Oct-7-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude to Health
Brain Injuries - diagnosis - epidemiology
Causality
Comorbidity
Cross-Sectional Studies
Female
Follow-Up Studies
Health status
Homeless Persons - psychology - statistics & numerical data
Humans
Incidence
Injury Severity Score
Male
Mental health
Middle Aged
Ontario - epidemiology
Probability
Reference Values
Risk factors
Risk-Taking
Socioeconomic Factors
Substance-Related Disorders - diagnosis - epidemiology
Survival Rate
Abstract
We sought to determine the lifetime prevalence of traumatic brain injury and its association with current health conditions in a representative sample of homeless people in Toronto, Ontario.
We surveyed 601 men and 303 women at homeless shelters and meal programs in 2004-2005 (response rate 76%). We defined traumatic brain injury as any self-reported head injury that left the person dazed, confused, disoriented or unconscious. Injuries resulting in unconsciousness lasting 30 minutes or longer were defined as moderate or severe. We assessed mental health, alcohol and drug problems in the past 30 days using the Addiction Severity Index. Physical and mental health status was assessed using the SF-12 health survey. We examined associations between traumatic brain injury and health conditions.
The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness. After adjustment for demographic characteristics and lifetime duration of homelessness, a history of moderate or severe traumatic brain injury was associated with significantly increased likelihood of seizures (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8 to 5.6), mental health problems (OR 2.5, 95% CI 1.5 to 4.1), drug problems (OR 1.6, 95% CI 1.1 to 2.5), poorer physical health status (-8.3 points, 95% CI -11.1 to -5.5) and poorer mental health status (-6.0 points, 95% CI -8.3 to -3.7).
Prior traumatic brain injury is very common among homeless people and is associated with poorer health.
Notes
Cites: Brain Inj. 2001 Nov;15(11):935-4511689092
Cites: J Head Trauma Rehabil. 2007 Nov-Dec;22(6):330-818025965
Cites: Brain Inj. 2003 Sep;17(9):731-4112850940
Cites: Arch Intern Med. 2003 Nov 10;163(20):2492-914609786
Cites: J Nerv Ment Dis. 2004 Jul;192(7):471-815232317
Cites: J R Soc Med. 2004 Aug;97(8):375-915286189
Cites: J Urban Health. 2004 Dec;81(4):596-60515466841
Cites: J Neuropsychiatry Clin Neurosci. 1990 Winter;2(1):15-92136059
Cites: J Subst Abuse Treat. 1992;9(3):199-2131334156
Cites: Epidemiol Rev. 1993;15(2):546-568174670
Cites: J Subst Abuse Treat. 1994 Nov-Dec;11(6):541-87884837
Cites: Arch Phys Med Rehabil. 1995 Apr;76(4):302-97717829
Cites: J Stud Alcohol. 1995 Mar;56(2):161-77760561
Cites: Annu Rev Public Health. 1996;17:311-368724230
Cites: Subst Use Misuse. 1996 May;31(6):729-518816118
Cites: Br J Psychiatry. 1996 Oct;169(4):434-98894193
Cites: Am J Public Health. 1997 Feb;87(2):249-559103105
Cites: Am J Public Health. 1998 Nov;88(11):1651-79807531
Cites: Am J Phys Med Rehabil. 2006 Apr;85(4):343-8216554685
Cites: Brain Inj. 2006 May;20(5):499-50616716996
Cites: Neuropsychol Rehabil. 2006 Oct;16(5):537-6016952892
Cites: Health Serv Res. 2002 Jun;37(3):733-5012132603
PubMed ID
18838453 View in PubMed
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Traumatic brain injury occurring at work.

https://arctichealth.org/en/permalink/ahliterature164657
Source
NeuroRehabilitation. 2006;21(4):269-78
Publication Type
Article
Date
2006
Author
Hwan Kim
Angela Colantonio
Mary Chipman
Author Affiliation
Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada. hwan.kim@utoronto.ca
Source
NeuroRehabilitation. 2006;21(4):269-78
Date
2006
Language
English
Publication Type
Article
Keywords
Accidents, Occupational - statistics & numerical data
Adolescent
Adult
Age Distribution
Brain Injuries - epidemiology - psychology - therapy
Female
Hospital Mortality
Humans
Injury Severity Score
Length of Stay - statistics & numerical data
Male
Middle Aged
Occupational Diseases - epidemiology - psychology - therapy
Ontario - epidemiology
Risk factors
Sex Distribution
Treatment Outcome
Abstract
Traumatic brain injury (TBI) occurring in the workplace carries major economic repercussions such as lost wages and hospital costs. Little is known about the profile of risk factors for work-related traumatic brain injury.
This study describes the pre-injury demographic characteristics, injury-related characteristics and outcomes of work-related TBI and compares them with those of non work-related TBI. This study aims to provide profiles of work-related TBI to improve our understanding and awareness of TBI in the workplace and to better inform prevention efforts.
Cross-sectional study using the Comprehensive Data Set (CDS) of Ontario (Canada) Trauma Registry (OTR) from 1993 to 2001. Cases with the ICD-9-CM codes for head injury were included in the database of serious injuries from lead trauma hospitals.
The study identified 950 (7.3%) people with work-related TBI. Pre-injury demographics and injury-related characteristics of work-related TBI were significantly different from non work-related TBI such as age, gender, mechanisms of injury, Injury Severity Score, length of stay and in-hospital death.
This research provides the first comprehensive overview of work-related TBI based on Canadian data. It identifies high risk profiles to better target prevention.
PubMed ID
17361044 View in PubMed
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Trends in hospitalization associated with traumatic brain injury in a publicly insured population, 1992-2002.

https://arctichealth.org/en/permalink/ahliterature153258
Source
J Trauma. 2009 Jan;66(1):179-83
Publication Type
Article
Date
Jan-2009
Author
Angela Colantonio
Ruth Croxford
Samina Farooq
Audrey Laporte
Peter C Coyte
Author Affiliation
Department of Occupational Science and Occupational Therapy, Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada. angela.colantonio@utoronto.ca
Source
J Trauma. 2009 Jan;66(1):179-83
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Brain Injuries - economics - epidemiology - mortality
Cause of Death
Child
Child, Preschool
Female
Hospital Mortality
Hospitalization - trends
Humans
Infant
Infant, Newborn
Injury Severity Score
Logistic Models
Male
Middle Aged
Ontario - epidemiology
Registries
Risk factors
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in developed countries. We document trends in TBI-related hospitalizations in Ontario, Canada, between April 1992 and March 2002, focusing on relationships between inpatient hospitalization rates, age, sex, cause of injury, severity level, and in-hospital mortality.
Information on all acute hospital separations in Ontario with a diagnosis of TBI was analyzed using logistic regression.
Hospitalization rates fell steeply among children and young adults but remained stable among adults aged 66 and older. The proportion of TBI hospitalizations with mild injuries decreased from 75% to 54%, whereas the proportion with moderate injuries increased from 19% to 37%. Adjusting for other risk factors, in-hospital deaths were higher for injuries because of motor vehicle crashes than those because of falls. In-hospital death rates were stable for patients with moderate or severe injuries, but increased over time among those whose injuries were classified as mild, suggesting a trend toward more serious injury within the "mild" classification.
Hospitalizations for TBI involve fewer mild injuries over time and are highest in the oldest segment of the population.
PubMed ID
19131822 View in PubMed
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7 records – page 1 of 1.