Early Rehabilitation for Traumatic Brain Injury in New

Early Rehabilitation for Traumatic Brain Injury in New Zealand New Zealand Rehabilitation Conference 8-10 September, 2017 Christchurch Allison Foster, PhD ABI Rehabilitation Traumatic brain injury in New Zealand An injury that doesnt discriminate Proportionally higher incidence in NZ The total incidence of TBI per 100,000 person-years was 790 cases; incidence per 100,000 person-years of mild TBI was 749 cases and of moderate to severe TBI was 41 cases. Previous international epidemiological studies placed overall incidence at 200558 per 100,000 population. Lancet Neurol 2013; 12: 5364 Traumatic brain injury in New Zealand The average cost per

new TBI case during the first 12 months and over a lifetime was US $5,922, varying from US $4,636 for mild cases to US $36,648 for moderate/ severe cases. Neurology 2014;83:16451652 Our rehabilitation service ACC contract includes all cases of moderate-tosevere TBI that occur in 16 DHB regions Two inpatient facilities for intensive TBI-specific rehab in Auckland and Wellington BINS Acute hospital IDT inpatient rehab

Providers, ACC Community and longterm rehab Characterising early (post-acute) TBI rehab across the majority of NZ A retrospective review of de-identified service records was completed. All consecutive discharges over a 36month period (2014-2017) were included. Data from both sites were combined. Demographics N=715 Admissions: 697 first-time admissions 18 re-admissions Referrals: 675 admitted from acute hospital 40 admitted from community / other

Year 1: 216 Year 2: 231 Year 3: 268 Waitemata Counties Manukau Waikato Auckland Capital and Coast Northland Mid Central Hutt Valley Hawkes Bay Bay of Plenty Lakes Whanganui Taranaki Wairarapa Nelson-Marlborough Not NZ Tairawhiti Southern

17.3% 13.0% 12.7% 11.9% 7.8% 7.8% 6.4% 3.8% 3.6% 2.9% 2.7% 2.2% 2.1% 2.0% 1.3% 1.1% 1.1% 0.1% Demographics 26.4% women

73.6% men Average age: 43.2 19.6 Range: 15-88 180 160 140 120 100 80 60 40 20 0 Under 20 20-29 30-39 40-49

50-59 60-69 70-79 80-89 Demographics Beneficiary; 9.64% Other / not Pacific; 5.87% stated; 4.34% Asian; 7.97% Maori; 24.76% European; 57.06%

Unemployed; 10.26% Student; 11.35% Employed; 55.21% Retired; 13.53% Ethnicity Employment Injury descriptions Sports; 2.10% Other; 7.13% Vehicle; Pedestrian; 34.13% 6.29% Assault;

17.48% Fall; 32.87% Mechanism of Injury Injury descriptions Average GCS = 10.1 4.5 Average PTA = 29.5 days 29.1 Mild; 1.10% Chronic amnesia; 1.10% Severe; 35.06% Still in PTA at time of Moderate; 9.62% discharge;

15.62% Mild; 45.41% Moderate; 19.53% Glasgow Coma Scale Severe; 72.56% Post-Traumatic Amnesia Injury descriptions AN-SNAP classes (AROC v.3) 200 180 160 140

120 100 80 60 40 20 0 210 211 212 213 214 Brain Dysfunction Less severe More severe

215 238 239 240 241 MMT Less severe More severe Other N/A Hospital and rehab course

Hospital length of stay: 22.0 days 23.8 Rehab length of stay: 41.5 days 47.9 Inclusive of Returns to hospital: 21% of clients, average 3.6 days 5.9 Nights at home: 65% of clients, average 5.4 days 6.1 Other time away: 11% of clients, average 0.8 days 1.7 Hospital 22 days In PTA 29.5 days Rehab 41.5 days Community Outcomes FIM (cog)

FIM (motor) FIM total FAM DOM Admission 20.0 8.2 57.9 25.9 77.9 32.6 39.2 15.4 5.3 1.3 Discharge

28.6 6.2 82.6 17.2 111.2 22.0 67.2 14.1 18.7 9.0 Gain 8.5 24.2 32.7 32.7 FIM points gained over 41.5 days = FIM efficiency of 0.8 Outcomes Rest Home;

1.96% Another Rehab Hospital; Facility; 3.50% 5.03% Home; 89.51% Minimally conscious clients 27 people 24 cleared the minimally conscious state On average, clients stayed 43.8 days in hospital and 120 days at ABI 48% went home after ABI 28% went on to further rehab 24% were discharged to hospital-level care Discussion Our incidence is approximately 7.0 per 100,000 population, per year Data contributing to AROC for benchmarking in NZ

and internationally Supporting quality improvement Example of data in action Does payment scheme influence the course of rehab? Rehabilitation Complexity Scale (0-3 scales) Care Skilled Nursing Therapy Disciplines Therapy Intensity Medical 0-15 total 0-3 very light 4-6 light 7-9 average 10-12 heavy 13-15 very heavy Does payment scheme influence the course of rehab?

Proportions of Clients by Rehabilitation Complexity Scale Categories, 2011 vs. 2015 Proportion of Clients with Short, Medium, and Long Lengths of Stay, 2011 vs. 2015 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20%

10% 20% 0% 10% 0% V Light, 0 to 3 Light, 4 to 6 Avg, 7 to 9 Heavy, 10 to 12 VeryCalendar Heavy, 13year to 2011 15 Calendar year 2015 Calendar year 2011 Short (8-30 days) Calendar year 2015

Med (31-90 days) Long (91+ days) Lets get started! ABI Rehabilitation Thank you to colleagues at ABI and the people we serve www.abi-rehab.co.nz www.abi-rehab.co.nz/outcomes [email protected]

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