Predicting Case Management Service Use Following Traumatic Brain Injury (TBI): A Critical Appraisal of the Caregiver Information and Support Link (CISL) Database
The practice of CM occurs within the context of varied health delivery systems and populations worldwide, and it has emerged as a significant health service for persons with TBI (Quinn, Pannone, Gruman & Roja, 2004).The primary aim of the study was to examine factors associated with the use of case management (CM) services by adolescents and adults with TBI based on data from CISL. A secondary objective was to provide a critical appraisal of the CISL.
This research involved secondary analysis of data from the CISL database which developed as part of a Canadian provincially-funded project for survivors and caregivers living with TBI. Data collected since 1989 included questions on service use. This was the only known extensive database in Canada that collected data on service use following TBI from the consumer perspective (N= 1,960 ). A primary purpose of the database was to assist in understanding the needs of persons living with TBI and their caregivers by collecting data directly from the source. Bivariate analyses were conducted comparing user and non-user groups of CM, and sequential (hierarchical) regression was performed using the framework of the Behavioral Model of Health Service Use (Anderson & Davidson, 2001). In addition, the generalizability of the CISL data was compared to administrative data from our publicly funded health care system of seriously injured persons from lead trauma hospitals in the province of Ontario.
Hierarchical regression analyses revealed that
age (older, less likely to use CM), education (less education, more likely to use CM), severity of injury (less severe, more likely to use CM), activity limitations (more limited, more likely to use CM), community integration (more integrated, the less likely to use CM), living at home alone (less likely to use CM), living in a facility (more likely to use CM), and funding by “other” insurance (less likely for worker’s insurance) significantly and reliably predicted use of CM services.
In addition, compared to population based data, the CISL data was not significantly different from the Ontario Trauma registry in terms of subject mean age (mean=37) and gender distribution.
Over half of the data were missing for key variables in the full CISL database.
Clear differences exist between CM users and non-users, suggesting further investigation into the use of and access to this component of the continuum of care following TBI. Although the CISL database was comparable to population based data in terms of demographic characteristics, the study revealed some weaknesses such as missing data for key variables. However, it provided unique data that is not available elsewhere in Canada on a large scale.
Baptiste B., Boschen K., Gibbs L., Dawson D.R., Colantonio A. & Streiner D.
Eighth World Congress on Brain Injury
Washington, DC, USA (March 10-14, 2010)
Clinical research, post-acute care (including vocational, educational and life long care issues) Friday, March 12, 2010. 8th World Congress Day 2: Lunch & Poster Presentations -- Session B - 1:00pm-2:30pm