Outcomes Following Inpatient Rehabilitation Following ...braininjurycanada.ca/wp-content/uploads/2014/10/Liam_Dessureault... · Outcomes Following Inpatient Rehabilitation Following

Outcomes Following Inpatient Rehabilitation Following Brain Injury:

Who is Treated…and How Do They Do?

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Presented by Liam Dessureault PT, MSc

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“Once you set aside the acute phases or crises that mark injury or disease, much of modern health care is indeed rehabilitation in one form or another.”

David Naylor, MD, Former President, University of Toronto

Situating Rehabilitation Services Information Along a Continuum

• Inpatient acute care units • Ambulatory hospital services • Inpatient hospital general rehabilitation units • Inpatient specialty freestanding rehabilitation

hospitals • Inpatient hospital continuing care units • Long term care facility settings • Community-based ambulatory clinics • Home-based services

Services included at

present

National Rehabilitation Reporting System (NRS)

DATA SOURCE • Adult inpatient rehabilitation (IR) programs

• ~100 participating facilities in 9 provinces

• Data collected at admission and discharge (and, optionally, at follow-up)

• Data submitted quarterly

DATA REPORTING • Public: NRS Quick Stats (CIHI Website)

• Private: NRS eReports (facility comparisons)

• Data releases to Ministries of Health, on request, ad hoc reporting in CIHI Portal

DATA AVAILABILITY • 2000 to present

NRS Captures Key Rehabilitation Data

Basic ADL Instrumental ADL

Cognitive Function

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Pre & Post Living Environments Vocational Status Informal Support

Adm and D/C Wait Times Service Referrals

Reason for Discharge Program Type

Diagnostic Conditions (ICD-10-CA) Reason for Referral

Onset Time

Grouping Clients in the NRS

a) Diagnostic Health Conditions – Pick-list of ICD-10-CA codes – Most responsible health condition (one) – Co-morbid health conditions (pre- and/or post-

admission) b) Rehab Client Group (RCG)

– Primary way of grouping clients for analysis c) Rehab Patient Group (RPG)

– Case Mix grouping methodology – Based on RCG, age and function scores (FIM®

instrument) – Predicts Resource Intensity during inpatient

rehabilitation (IR)

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You are right here

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Goals Met: Discharged to a Permanent

Living Setting, 81%

Most IR Clients Meet their Goals and Return to the Community

Source: NRS, CIHI 2012-2013 N=35,975

Clients Enter and Leave Rehabilitation with Varying Levels of Function

0

200

400

600

800

1000

1200

1400

1600

1800

18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120 126

Num

ber o

f Clie

nts

Total Function Score Admission Discharge

Source : NRS, CIHI 2010- 2011

(N=36,189) Mean=82.1 Median=84

(N=34,364) Mean=103.4 Median=110

Function scores referenced herein are based on data collected using the FIM® instrument. The 18-item FIM® instrument is the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

Change in Total Function Scores Varies by Reason for Admission

0 5 10 15 20 25 30

Major Multiple TraumaBurns

Spinal Cord DysfunctionOrthopedic Conditions

StrokeMedically Complex

Brain DysfunctionNeurological Conditions

Pain SyndromesCardiacDebility

Other Disabling ImpairmentsAmputation of Limb

ArthritisPulmonary

Congenital Deformities

Source: NRS, CIHI 2012-2013 N=35,975

Outcomes Following Inpatient Rehabilitation Following Brain Injury:

Who is Treated…and How Do They Do?

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Number of Admissions to Inpatient Rehab on the Rise

0

200

400

600

800

1000

1200

2008 2009 2010 2011 2012 2013

Non-Traumatic

Traumatic

N= 10,321 17 Source: NRS, CIHI 2008-2013

Inpatient Rehabilitation after Brain Injury: Quick Demographics of the Last 6 Years

Median AGE

Non-Traumatic (N=4759)

Traumatic (N=5562)

51% Male

70% Male

63 y.o.

51 y.o.

18 Source: NRS, CIHI 2008-2013

What Were the Most Common Mental and Behavioural Health Conditions?

0 2 4 6 8 10 12 14

Recurrent depressive disorder

Depressive episode

Mental and behavioural disorders due to use of alcohol

Other mental disorders due to brain dysfunction

Other anxiety disorders

Personality and behavioural disorders due to braindysfunction

Delirium

Unspecified Dementia

Dementia in Alzheimer's disease with early onset

% of Cases

19 Source: NRS, CIHI 2008-2013 N= 10,321

How Many Days Between Onset to Rehab Admission?

49

33

25

41

26

15

Most ResourceIntensive

ModeratelyResource Intensive

Least ResourceIntensive

Traumatic

Non-Traumatic

20 Source: NRS, CIHI 2008-2013 N=10,321

How Many Onset Days are Spent Waiting for Admission to Rehab?




Traumatic

Non-Traumatic

6 5 4 4 3 2

N= 3217

N= 2782

21 Source: NRS, CIHI 2008-2013 (N= 10,321)

How Many Days Spent in Rehab?

81

48

30

57

37

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Most Resource Intensive Moderately ResourceIntensive

Least Resource Intensive

Traumatic

Non-Traumatic

22 Source: NRS, CIHI 2008-2013 N= 10,321

How Many of those Days are Spent Waiting to Leave Rehab?

(N= 10,321)

Most Resource Intensive Moderately ResourceIntensive

Least Resource Intensive

Traumatic

Non-Traumatic

15 10 4 7 7 1

N= 566

N= 696


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25

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Communication in Highest Disability Patients: Significant Help Needed on D/C

Helper Present

No Helper

Helper Hands

On

FIM® Rating

N= 3,284 of 10,321

Non-Traumatic Traumatic


1

2

3

4

5

6

7

Comprehension Expression Comprehension Expression

FunctionChangeAdmissionFunction

Most Brain Injury Patients were Seen by a Speech Language Pathologist

55% 68%

Non Traumatic Traumatic (N=5562) (N=4759)


“Social Cognition” in Lowest Disability Patients: Benefits for Traumatic Group

Helper Present

No Helper

Helper: Hands

On


1

2

3

4

5

6

7

Memory ProblemSolving

SocialInteraction


SocialInteraction

Function Change

Admission Rating

FIM® Rating

N= 3,276 of 10,321 Source: NRS, CIHI 2008-2013

“Social Cognition” in Moderate Disability Patients: Help Req’d on D/C

Helper Present

No Helper

Helper Hands

On

FIM® Rating

N= 3,761 of 10,321

1

2

3

4

5

6

7


SocialInteraction


SocialInteraction

Function Change

Admission Rating



“Social Cognition” in Highest Disability Patients: Significant Help Needed on D/C

Helper Present

No Helper

Helper Hands

On

FIM® Rating

N= 3,284 of 10,321

1

2

3

4

5

6

7


SocialInteraction


SocialInteraction

Function Change

Admission Rating



Bowel & Bladder Control in Highest Disability Patients: Help Req’d on D/C

Helper Present

No Helper

Helper Hands

On

FIM® Rating Non-Traumatic Traumatic

1

2

3

4

5

6

7

BowelManagement

BladderManagement

BowelManagement

BladderManagement

FunctionChange

AdmissionRating

32 Source: NRS, CIHI 2008-2013 N= 3,284 of 10,321

Rate of Return to Home over 2 times Higher than Return to Work (within one month)

50%

71%

83%

21% 28%

39%




Returned home

Returned to work

(of 5147 admitted from home)

(of 2255 previously working)


Traumatic Brain Injury

Summary of Findings • Inpatient Rehabilitation (IR) admissions for Brain

Dysfunction on the rise • Higher disability, longer time to IR admission and

longer wait once ready for IR discharge • “Depression” is most commonly coded mental

health comorbidity in IR

• On discharge from IR – 2/3 require help with cognitive tasks – 2/3 require significant help/equipment to manage

bladder and/or bowel – Rate of returning home is 2 to 3 times the rate of

returning to work 34

What Lies Around the Bend for Brain Injury Health Information Services

• Enhanced guidelines for ICD-10-CA diagnoses and classification in NRS

• Refinement of case mix grouping methodology in NRS

• Additional outpatient/ambulatory rehab reporting for brain injury

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You are right here

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-Pierre Louis Lapointe (2004) Les Editions GID

Let’s spark some interest in rehabilitation data

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Questions?

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Outcomes Following Inpatient Rehabilitation Following ...braininjurycanada.ca/wp-content/uploads/2014/10/Liam_Dessureault... · Outcomes Following Inpatient Rehabilitation Following