Abstract
Objective
To identify determinants of discharge disposition from acute care among survivors
of hypoxic-ischemic brain injury (HIBI), stratified by sex.
Design
Population-based retrospective cohort study using provincial data in Ontario, Canada.
The determinants were grouped into predisposing, need, and enabling factors using
the Anderson Behavioral Model.
Setting
Acute care.
Participants
Survivors of HIBI aged ≥20 years at the time of hospitalization and discharged alive
from acute care between April 1, 2002, and March 31, 2017. There were 7492 patients
with HIBI, of whom 28% (N=2077) survived their acute care episode.
Interventions
Not applicable.
Main Outcome Measures
Discharge disposition from acute care, categorized as complex continuing care (CCC),
long-term care (LTC), inpatient rehabilitation (IR), home with support, home without
support, and transferred to another acute care.
Results
The discharge dispositions for the 2077 survivors were IR 23.4% (n=487), CCC 19.5%
(n=404), LTC 6.2% (n=128), home without support 31.2% (n=647), home with support 15.1%
(n=314), and other 4.6%. Multinomial multivariable logistic regression analysis using
home without support as the reference category revealed that female patients were
significantly more likely than male patients to be discharged to LTC/CCC. Those who
were older, were frail, and had longer stay in acute care or special care unit (SCU)
were more likely to be discharged to LTC/CCC. The only significant determinant for
IR was longer stay in acute care. Survivors with cardiac-related injury were less
likely to be discharged to LTC/CCC. Income was a significant factor for male patients
but not for female patients in the sex-stratified analysis. The following variables
were investigated but were not significant determinants in this study: need factors
(comorbidity score, prior psychiatric disorders, health care utilization) and enabling
factors (income quintile, rural area of residence).
Conclusions
Predisposing (age, sex) and need factors (frailty, acute care days, SCU days, type
of injury) were significant determinants of discharge disposition from acute care
after HIBI. In spite of a system with universal coverage, sex differences were found,
with more female patients being discharged to CCC/LTC rather than IR, controlling
for age and other confounders. These findings should be considered in appropriate
discharge planning from acute care for survivors of HIBI.
Keywords
List of abbreviations:
ABI (acquired brain injury), ACG (Adjusted Clinical Group), ADG (Aggregated Diagnosis Group), ALC (alternate level of care), aOR (adjusted odds ratio), CCC (complex continuing care), CI (confidence interval), DAD (Discharge Abstract Database), HIBI (hypoxic-ischemic brain injury), IR (inpatient rehabilitation), LOS (length of stay), LTC (long-term care), OR (odds ratio), SCU (special care unit), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 17, 2021
Footnotes
Supported by the Canadian Institute of Health Research (CIHR) (funding reference no. PJT-153129). The analyses, conclusions, opinions, and statements expressed herein are those of the authors and are not influenced by CIHR.
Disclosures: none.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine
