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Re-hospitalization after Traumatic Brain Injury: A Population Based Study
e24 Participants: 6,247 patients were admitted between January 2006 - June 2014 to the Level I trauma center with acute TBI; 514 died during initial hospitalization, leaving 5,733 patients for final analysis. Interventions: N/A. Main Outcome Measure(s): Healthcare utilization post TBI and charges. Results: The sample was primarily Caucasian (58%), male (66%), uninsured (39%), and with a mean age of 49.1 (21.7) at time of injury. Additional healthcare utilization following admission was recorded for 3,677 patients, totaling 13,850 encounters with a median of two encounters and maximum of 102. 11,119 encounters were outpatient visits (80%) with a median charge of $1,772, with most common types of encounter being elective (45%) and medical emergency (30%). The remaining 2,731 encounters (20%) were inpatient visits, with a mean length of stay of 5 days, median charge of $28,073, and primary reasons being medical emergency (39%) and elective admissions (34%). Conclusions: Tracking healthcare utilization post-TBI is challenging as visits may occur outside of the original admitting hospital. This analysis encompasses utilization across numerous systems allowing for a clearer description of readmissions. Clarifying reasons for healthcare utilization post-TBI may be the first step to develop preventative interventions. Key Words: Acute Brain Injuries, Health services, Hospital admissions Disclosure(s): The authors graciously acknowledge support in the form of grants from the Stanley Seeger and Ginger Murchison Funds of the Baylor Foundation.
Research Poster 4946 Improving Participation after Stroke: A Self-Management Program for a Healthy and Active Lifestyle after Stroke Danbi Lee (University of Illinois at Chicago), Joy Hammel, Carolyn Baum, Timothy Wolf Objective(s): To evaluate if a stroke self-management intervention will improve stroke survivors’ self-efficacy in managing a healthy and active life style. Design: Randomized, wait-list controlled study with measurements at baseline and post-intervention. Setting: Community based setting. Participants: 97 community-dwelling individuals (nZ66 in intervention group, nZ31 in wait-list group) with mild to moderate stroke. Interventions: A 12-session intervention including the standardized Stanford Chronic Disease Self-Management program and the Improving Participation After Stroke Self-management (IPASS) program was provided. The IPASS program is a novel 7-session manualized group-based program promoting active participation in home, community, work, and social activities post stroke. The 12-session intervention guided participants to develop skills in problem solving, decision making, resource utilization, action-planning and self-tailoring. Main Outcome Measure(s): Self-efficacy in using strategies for home, work, community, and social participation management as measured with Participation Strategies Self-Efficacy Scale (PS-SES). Results: Repeated measures ANOVA with between group comparison of the pre-post treatment data revealed significant improvement in the intervention group in four out of six subcategories of the PS-SES (p<0.05): 1) managing home, 2) staying organized, 3) managing community, and 4) advocating for resources with effect sizes ranging from 0.53 to 0.94. The average effect size across all six subcategories was 0.55 indicating moderate overall impact of the intervention on participation management. Conclusions: The results shows that the 12 week intervention combining the Stanford Chronic Disease Self-management program and a novel stroke specific self-management program creates synergy in improving home and community participation outcomes among people with stroke. The study offers new conceptualization of
Research Posters self-management by showing that the tenets of self-management can be applied beyond management of chronic diseases to promotion of community participation. Key Words: Stroke, Social Participation, Rehabilitation Disclosure(s): None Disclosed. Research Poster 4947 Re-hospitalization after Traumatic Brain Injury: A Population Based Study Cristina Saverino (Toronto Rehabilitation Institute), Bonnie Swaine, Susan Jaglal, John Lewko, Lee Vernich, Andrew Calzavara, Angela Colantonio Objective(s): To examine from a Canadian population-based perspective, the incidence and etiology of long-term hospital utilization among persons living with traumatic brain injury (TBI) by age and sex. Design: Retrospective cohort study. Setting: Acute care hospitals in Ontario. Participants: Index cases of TBI (NZ29,269) were identified from the Discharge Abstract Database for fiscal years 2002/03 through 2009/10 and were followed up to 36 months after injury. Interventions: N/A. Main Outcome Measure(s): Rehospitalization was defined as admission to an acute care facility that occurred up to 36 months after index injury. Diagnoses associated with subsequent rehospitalizations were examined by age and sex. Results: Of the patients with TBI, 35.5% (nZ10,390) were subsequently hospitalized during the 3 year follow-up period. Multivariable logistic regression (controlling for index admission hospital) identified men, older age, mechanism of injury being a fall, greater injury severity, rural residence, greater comorbidity and psychiatric comorbidity to be significant predictors of rehospitalization in a 3-year period post injury. The most common causes for re-hospitalization differed by age and sex. Conclusions: Rehospitalization after TBI is common. Factors associated with rehospitalization can inform long-term post discharge planning. Findings also support examining causes for re-hospitalization by age and sex. Key Words: Rehospitalization, Traumatic Brain Injury, Population Based Study, Sex Differences, Age Differences Disclosure(s): None Disclosed. Research Poster 4949 Impact of Inaccessible Spaces on Community Participation of People with Mobility Limitations in Zambia Martha C. Banda (University of Zambia, School of Medicine, Department of Physiotherapy) Objective(s): Investigate the perspective of people with mobility limitations (PWML) in Zambia, of their accessibility of public buildings and spaces, and of how their capacity to participate in a preferred lifestyle had been affected. (i) To provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia, (ii) To establish how the Zambian disability context shape the experiences of participation by PWML. Design: Survey design using qualitative method of data collection. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family’s participation experiences. The nominal group technique was utilized to rank inaccessible buildings and facilities, which posed barriers to opportunities in life areas and how this interfered with the whole family’s lifestyle.
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Research Poster 4946 Improving Participation after Stroke: A Self-Management Program for a Healthy and Active Lifestyle after Stroke Danbi Lee (University of Illinois at Chicago), Joy Hammel, Carolyn Baum, Timothy Wolf Objective(s): To evaluate if a stroke self-management intervention will improve stroke survivors’ self-efficacy in managing a healthy and active life style. Design: Randomized, wait-list controlled study with measurements at baseline and post-intervention. Setting: Community based setting. Participants: 97 community-dwelling individuals (nZ66 in intervention group, nZ31 in wait-list group) with mild to moderate stroke. Interventions: A 12-session intervention including the standardized Stanford Chronic Disease Self-Management program and the Improving Participation After Stroke Self-management (IPASS) program was provided. The IPASS program is a novel 7-session manualized group-based program promoting active participation in home, community, work, and social activities post stroke. The 12-session intervention guided participants to develop skills in problem solving, decision making, resource utilization, action-planning and self-tailoring. Main Outcome Measure(s): Self-efficacy in using strategies for home, work, community, and social participation management as measured with Participation Strategies Self-Efficacy Scale (PS-SES). Results: Repeated measures ANOVA with between group comparison of the pre-post treatment data revealed significant improvement in the intervention group in four out of six subcategories of the PS-SES (p<0.05): 1) managing home, 2) staying organized, 3) managing community, and 4) advocating for resources with effect sizes ranging from 0.53 to 0.94. The average effect size across all six subcategories was 0.55 indicating moderate overall impact of the intervention on participation management. Conclusions: The results shows that the 12 week intervention combining the Stanford Chronic Disease Self-management program and a novel stroke specific self-management program creates synergy in improving home and community participation outcomes among people with stroke. The study offers new conceptualization of
Research Posters self-management by showing that the tenets of self-management can be applied beyond management of chronic diseases to promotion of community participation. Key Words: Stroke, Social Participation, Rehabilitation Disclosure(s): None Disclosed. Research Poster 4947 Re-hospitalization after Traumatic Brain Injury: A Population Based Study Cristina Saverino (Toronto Rehabilitation Institute), Bonnie Swaine, Susan Jaglal, John Lewko, Lee Vernich, Andrew Calzavara, Angela Colantonio Objective(s): To examine from a Canadian population-based perspective, the incidence and etiology of long-term hospital utilization among persons living with traumatic brain injury (TBI) by age and sex. Design: Retrospective cohort study. Setting: Acute care hospitals in Ontario. Participants: Index cases of TBI (NZ29,269) were identified from the Discharge Abstract Database for fiscal years 2002/03 through 2009/10 and were followed up to 36 months after injury. Interventions: N/A. Main Outcome Measure(s): Rehospitalization was defined as admission to an acute care facility that occurred up to 36 months after index injury. Diagnoses associated with subsequent rehospitalizations were examined by age and sex. Results: Of the patients with TBI, 35.5% (nZ10,390) were subsequently hospitalized during the 3 year follow-up period. Multivariable logistic regression (controlling for index admission hospital) identified men, older age, mechanism of injury being a fall, greater injury severity, rural residence, greater comorbidity and psychiatric comorbidity to be significant predictors of rehospitalization in a 3-year period post injury. The most common causes for re-hospitalization differed by age and sex. Conclusions: Rehospitalization after TBI is common. Factors associated with rehospitalization can inform long-term post discharge planning. Findings also support examining causes for re-hospitalization by age and sex. Key Words: Rehospitalization, Traumatic Brain Injury, Population Based Study, Sex Differences, Age Differences Disclosure(s): None Disclosed. Research Poster 4949 Impact of Inaccessible Spaces on Community Participation of People with Mobility Limitations in Zambia Martha C. Banda (University of Zambia, School of Medicine, Department of Physiotherapy) Objective(s): Investigate the perspective of people with mobility limitations (PWML) in Zambia, of their accessibility of public buildings and spaces, and of how their capacity to participate in a preferred lifestyle had been affected. (i) To provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia, (ii) To establish how the Zambian disability context shape the experiences of participation by PWML. Design: Survey design using qualitative method of data collection. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family’s participation experiences. The nominal group technique was utilized to rank inaccessible buildings and facilities, which posed barriers to opportunities in life areas and how this interfered with the whole family’s lifestyle.
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