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7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 1/13
Association between fault status and patient-reportedoutcomes following orthopaedic trauma
Belinda Gabbe1, Pam Simpson1, David Attwood2, Greg Karstens2, David Gifford2, Melinda
Watt2, Alan Woodroffe2, Alex Collie1,3
1 Department of Epidemiology and Preventive Medicine, Monash University; 2 Transport Accident Commission; 3 Institute for
Safety Compensation and Recovery Research, Monash University
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 2/13
Background
• Numerous studies have observed poorer outcomes in
compensable patients compared to non-compensable
patients
• Attribution of fault or blame has been proposed as apotential explanatory factor for the differences
observed
• No clear consensus in the literature regarding the
impact of fault status on patient outcomes
2
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 3/13
Aim of the project
• Describe the association between fault status andpatient-reported outcomes
3
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 4/13
Methods
• Victorian Orthopaedic Trauma Outcomes Registry
(VOTOR)
– Sentinel site registry
– All orthopaedic trauma admissions >24h
– Routine telephone follow-up at 6-months and 12-months
• Linkage of VOTOR with Transport Accident Commission
(TAC) claims data
– Compensation Research Database (CRD) – Additional items directly from the TAC
• TAC cases from September 2010 to December 2011
4
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 5/13
Methods
Exposure of interest
• Fault status
– Police and self-report
– Categorised as
• Not at fault
• At fault
• Fault “in dispute”
Outcomes at 6 and 12-months
• Patient-reported
– SF-12 PCS and MCS scores
– GOS-E
– Pain
– Return to work
• TAC scheme costs
5
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 6/13
Data analysis
• Multivariable linear and logistic regression models
– Quantify association between fault status and outcome adjusted for key
potential confounders
– Covariates used included age, gender, nature of injury, level of education,
pre-injury work status, road user group and comorbid status
– Total TAC claim costs were log transformed for analysis
– Adjusted odds ratio (OR) and 95% CI for logistic models
– Adjusted mean difference and 95% CI for linear models
– Adjusted percentage change in the mean and 95% CI for cost models
6
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 7/13
Results
7
N=1470 cases09/2010-12/2011
N=1290 with faultstatus recorded
N=571 At fault
N=578 Not at fault
N=141 In disputeN=117 missing faultstatus
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 8/13
Results – 6 month outcomes
8
Outcome at 6-months
Fault category N n (%) with
outcome
*AOR (95% CI) p-value
Good recovery At fault (reference) 514 176 (34.2) 1
In dispute 124 31 (25.0) 0.50 (0.30, 0.83) 0.01
Not at fault 523 159 (30.4) 0.70 (0.51, 0.95) 0.02
Complete recovery At fault (reference) 514 101 (19.7) 1
In dispute 124 15 (12.1) 0.48 (0.25, 0.92)
0.03
Not at fault 523 74 (14.2) 0.67 (0.46, 0.98)
0.04
Return to work At fault (reference) 391 241 (61.6) 1
In dispute 89 53 (59.6) 0.68 (0.39, 1.18) 0.17
Not at fault 380 218 (57.4) 0.67 (0.47, 0.95) 0.03
Moderate/severe pain At fault (reference) 436 101 (23.2) 1
In dispute 111 37 (33.3) 1.81 (1.11, 2.95)
0.02
Not at fault 445 121 (27.2) 1.20 (0.85, 1.70) 0.31
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 9/13
Results – 6 month outcomes
9
Outcome at 6-months
Fault category N Mean (sd) *Adjusted change
from no fault group
(95% CI)
p-value
PCS-12 At fault (reference) 397 39.9 (12.1) -
In dispute 98 37.3 (11.0) -3.2 (-5.7, -0.7) 0.01
Not at fault 401 37.0 (11.8) -3.0 (-4.7, -1.4) <0.001
MCS-12 At fault (reference) 397 50.8 (11.4) -
In dispute 98 48.1 (12.1) -2.7 (-5.3, -0.1) 0.04
Not at fault 401 49.9 (11.9) -1.1 (-2.9, 0.6) 0.20
Mean (sd) *Adjusted % change
from no fault group
(95% CI)
Cost At fault (reference) 570 56,167 (53,835) -
In dispute 139 55,651 (47,304) 8.1 (-8.5, 27.7) 0.36
Not at fault 573 61,250 (57,658) 11.4 (-0.1, 24.1) 0.05
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
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Results – 12 month outcomes
10
Outcome at 12-months
Fault category N n (%) with
outcome
*AOR (95% CI) p-value
Good recovery At fault (reference) 484 194 (40.1) 1
In dispute 124 44 (35.5) 0.71 (0.45, 1.14) 0.16
Not at fault 494 168 (34.0) 0.65 (0.48, 0.89) 0.01
Complete recovery At fault (reference) 484 124 (25.6) 1
In dispute 124 20 (16.1) 0.41 (0.23, 0.75) 0.004
Not at fault 494 92 (18.6) 0.57 (0.39, 0.81) 0.002
Return to work At fault (reference) 365 255 (69.9) 1
In dispute 90 63 (70.0) 0.88 (0.49, 1.57) 0.66
Not at fault 353 244 (69.1) 0.85 (0.58, 1.25) 0.42
Moderate/severe pain At fault (reference) 392 107 (27.3) 1
In dispute 101 31 (30.7) 1.48 (0.88, 2.49) 0.14
Not at fault 400 109 (27.3) 1.12 (0.78, 1.60) 0.55
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
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Results – 12 month outcomes
11
Outcome at 12-months
Fault category N Mean (sd) *Adjusted change
from no fault group(95% CI)
p-value
PCS-12 At fault (reference) 372 42.1 (12.8) -
In dispute 91 39.7 (11.5) -3.5 (-6.1, -0.8) 0.01
Not at fault 379 38.2 (11.9) -4.5 (-6.2, -2.7)
<0.001
MCS-12 At fault (reference) 372 50.1 (11.8) -
In dispute 91 47.0 (11.9) -3.8 (-6.5, -1.1) 0.01
Not at fault 379 49.0 (11.7) -1.6 (-3.4, 0.1) 0.07
Mean (sd) *Adjusted % change
from no fault group
(95% CI)
Cost At fault (reference) 330 65,614 (67,746) -
In dispute 92 62,052 (55,396) -1.8 (-21.9, 23.5) 0.88
Not at fault 298 75,587 (68,946) 10.9 (-5.9, 30.7) 0.22
7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
http://slidepdf.com/reader/full/association-between-fault-status-and-patient-reported-outcomes-following-orthopaedic 12/13
Conclusions
• Fault status is an important predictor of functional and
quality of life outcomes
• “In dispute” cases demonstrated poorer mental health at 6
and 12-months post-injury than “At fault” cases • Future directions
– Larger sample for investigation
– Investigate the direction of the “in dispute” claims further
– Establish whether fault status accounts for differences between
compensable and non-compensable cases
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7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013
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• “This project is funded by the Transport Accident
Commission, through the Institute for Safety,
Compensation and Recovery Research.”
13
Acknowledgements