reports

Homecare after pediatric traumatic brain injury: what do they use and how much does it cost?

Arch Phys Med Rehabil 96:e38.

University Health Network, Toronto, ON, Canada

Objective(s): To determine, by sex, the predictors, types, and direct cost of publicly funded homecare service within I-year of discharge from acute care among pediatrics with a traumatic brain injury (TBI).

Design: A retrospective cohort study using the National Ambulatory Care Reporting System, Discharge Abstract Database, and the Home Care Database, population based healthcare administrative databases.

Setting: Ontario, Canada between fiscal years 2006/07 and 2011/12.

Participants: Children and youth aged 19 years and under with a TBI in acute care identified by specified International Classification of Diseases Version JO Codes.

Interventions: N/A.

Main Outcome Measure(s): Predictors, types, and cost of homecare use one year after discharge from acute care by sex.

Results: Among 5,494 pediatric patients discharged from acute care between fiscal years 2006/07 and 20 /12, 14.7% (N=810) received publicly funded homecare services within the first year of acute care discharge. A total of 19,415 homecare claims were made, costing $2.4 million; 70% of these claims were made by boys, however, the cost per patient was higher among girls ($3,220 vs. $2.884). The most common types of services used included nursing, homemaking/personal support, and case management. Multivariable logistic regression showed that overall, increasing number of comorbidities (OR= I 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 TB! related emergency department visit (OR= 1.910) significantly increased the odds of homecare use. The factors that significantly predicted 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.