The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury

David N Borg; Jennifer Fleming; Joshua J Bon; Michele M Foster; Elizabeth Kendall; Timothy Geraghty

doi:10.1186/s12913-022-07811-y

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury

BMC Health Serv Res. 2022 Apr 5;22(1):445. doi: 10.1186/s12913-022-07811-y.

Authors

David N Borg^{1

2}, Jennifer Fleming³, Joshua J Bon^{4

5

6}, Michele M Foster^{4

7}, Elizabeth Kendall^{4

7}, Timothy Geraghty^{4

8}

Affiliations

¹ Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia. david.borg@griffith.edu.au.
² Griffith University, School of Allied Health Sciences, Brisbane, Australia. david.borg@griffith.edu.au.
³ University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia.
⁴ Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.
⁵ Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Brisbane, Australia.
⁶ Queensland University of Technology, School of Mathematical Sciences, Brisbane, Australia.
⁷ Griffith University, School of Allied Health Sciences, Brisbane, Australia.
⁸ Metro South Health Hospital and Health Service, Division of Rehabilitation, Brisbane, Australia.

Abstract

Background: This exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes.

Methods: Using a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees.

Results: There was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes.

Conclusions: This study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings.

Keywords: Access; Allied health; Rehabilitation.

MeSH terms

Adult
Bayes Theorem
Brain Injuries* / rehabilitation
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care
Prospective Studies
Quality of Life*