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Discharge Destination from Acute Care after Traumatic Brain Injury

Published online by Cambridge University Press:  02 December 2014

Hwan Kim ,
Angela Colantonio ,
Raisa Deber  and
Lee Vernich
Hwan Kim
Affiliation:
Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada
Angela Colantonio*
Affiliation:
Department of Occupational Therapy, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada
Raisa Deber
Affiliation:
Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
Lee Vernich
Affiliation:
Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
*
Department of Occupational Therapy, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada.
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Abstract:

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Objective:

To identify the impact of private insurance coverage on discharge disposition after a traumatic brain injury (TBI) using injury in a motor vehicle accident (MVA) as a proxy for private insurance, controlling for age and severity of injury.

Method:

Cross-sectional study.

Patients:

Patients with TBI discharged between 1993-1994 and 2000-2001 (n = 9,703).

Main Outcome Measure:

Discharge destination from acute care; controlled odds ratio (OR) and confidence interval (CI) for type of injury.

Results:

Type of injury, age, and length of stay are significantly associated with discharge destination. However, the motor vehicle accident patients are 56% more likely to be discharged to home with support services than patients with similar injuries from falls.

Conclusion:

Even in a system with universal coverage, availability of private insurance type is a potential independent determinant of postacute care services. More research is required to determine the effect this relationship has on the cost and outcomes of care for TBI patients.

Résumé

RÉSUMÉ Objectif:

Identifier l'impact d'une couverture par une assurance privée sur l'orientation des patients au congé d'une institution de soins actifs après un traumatisme crânien (TC). Un traumatisme subi lors d'un accident de la route a servi d'indicateur de substitution pour l'assurance privée, après ajustement pour l'âge et la sévérité de la lésion.

Méthodes:

Il s'agit d'une étude transversale.

Patients:

Les patients ayant subi une lésion cérébrale par traumatisme crânien qui ont reçu leur congé d'un hôpital de soins de courte durés entre 1993-1994 et 2000-2001 (n = 9 703).

Critère d’élvaluation principal:

L'orientation au congé était l'issue principale; le rapport de cotes et l'intervalle de confiance ont été ajustés pour le type de lésion.

Résultats:

Il existait une association significative entre l'orientation au moment du congé et le type de lésion, l'âge du patient et la durée de l'hospitalisation. Cependant, les patients qui ont subi un accident de la route sont 56% plus susceptibles d'être retournés à domicile avec des services d'appoint que les patients qui ont subi des lésions similaires à cause d'une chute.

Conclusion:

Même dans un système où il existe une couverture universelle des soins de santé, la disponibilité d'une assurance privée peut être un déterminant indépendant des services après la période de soins aigus. Son influence sur le coût et l'issue des soins chez les TC devront faire l'objet de recherches plus poussées.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 48 - 52
Copyright
Copyright © The Canadian Journal of Neurological 2006

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