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Children and youth with traumatic brain injury: Who uses homecare services, what do they use, and how much does it cost?

First International Conference on Pediatric Acquired Brain Injury, September 2015, Liverpool, UK.

University of Toronto, Toronto, ON, Canada

Objective: To determine, by sex, the predictors, types, and direct cost of publicly funded homecare services within 1-year post acute care discharge among children and youth with a traumatic brain injury (TBI).

Design: The National Ambulatory Reporting System, Discharge Abstract Database, and Home Care Database from Ontario, Canada, were used to identify TBI cases between fiscal years 2006/07 and 2011/12 using specified International Classification of Diseases Version 10 (ICD-10) Codes.

Results: Among 5,494 children and youth with TBI discharged from acute care between fiscal years 2006/07 and 2011/12, 14.7% (N=810) received publicly funded homecare services within 1-year of acute care discharge. The total cost of homecare services was $2.4 million for 19,415 homecare claims filed. Although 70% of these claims were made by boys, the cost per individual was higher among girls ($3,220.70 vs. $2,884.20). The most common types of services included nursing, homemaking/personal support, and case management. Significant predictors of homecare use included increasing number of ICD-10 Chapter Heading comorbidities (OR=1.251) and acute care length of stay (OR=1.016), special care days (OR=2.092), severe Abbreviated Injury Score (OR=1.567), and a previous TBI related emergency department visit (OR=1.910). Conversely, patients that were not injured in a motor vehicle collision (OR=0.691) and having a TBI as a most responsible diagnosis in acute care (OR=0.316) were significantly less likely to use homecare services. The factors that were significantly associated with homecare use differed by sex.

Conclusions: This paper presents comprehensive information on the predictors of homecare use by sex that can be used for the appropriate planning and allocation of homecare services for boys and girls with a TBI.