The Traumatic Brain Injury Model Systems of Care

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The Traumatic Brain Injury Model Systems of Care

• A project funded by the US Department of
  Education
• National Institute on Disability and
  Rehabilitation Research

Cindy Harrison-Felix, PhD Craig Hospital
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Database Objectives

• Study the clinical course of individuals with TBI
  from time of injury through discharge from acute
  care and rehabilitation care.
• Evaluate the recovery and long-term outcome of
  individuals with TBI.
• Establish a basis for comparison with other data
  sources.

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Definition of TBI

• The individual has sustained a TBI external
  mechanical force causing damage to brain tissue,
  as evidenced by any of the following
• loss of consciousness
• post-traumatic amnesia (PTA)
• objective neurological findings

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Database Inclusion Criteria

• Moderate to severe TBI (PTAgt24 hrs or LOCgt30
  minutes or GCS in EDlt13 or intracranial
  neuroimaging abnormalities)
• Admitted to systems hospital emergency
  department within 72 hours of injury.
• 16 years of age or older at the time of injury
• Receives acute care and comprehensive inpatient
  rehabilitation within the model system hospitals.
• Informed consent is signed by patient, family or
  guardian.

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NIDRR TBI National Database

• Form I - Acute care 214 variables
• Form II - Follow-up 153 variables
• Follow-up conducted 1,2,5, and every 5 years
  thereafter
• Follow-up methods in-person, phone, mail
  questionnaire

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National Database Syllabuswww.tbindsc.org
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Research Issues for Variable Selection

• Premorbid history
• Demographic characteristics of the population
• Causes and severity of injury
• Nature of diagnoses
• Types of treatment/services
• Costs of treatment/services
• Measurement and prediction of outcomes including
  impairment, disability and participation

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I. Premorbid History

• History of TBI
• Drug Use
• Alcohol use (NHSDA/BRFSS)
• Conditions and limitations
• Psychiatric History
• Arrests/felony incarcerations
• Learning/behavior problems

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II. Demographic Characteristics

• Age
• Gender
• Race
• Marital Status
• Residence
• Zip Code
• Living with
• Level of education
• Employment

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III. Causes of Injury

• Date of injury
• ICD-9 external cause of injury codes
• Blood alcohol level (limited data)

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III. Severity of Injury

• Glasgow Coma Scale Score
• Revised Trauma Score
• Duration of unconsciousness
• Duration of Post Traumatic Amnesia

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IV. Diagnoses

• Spinal Cord Injury
• Intracranial CT scan findings
• Intracranial hypertension
• Neuropsychological assessment
• ICD-9 diagnosis codes
• Cause of death

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V. Treatments

• Surgical procedures
• Rehospitalizations

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VI. Costs of Treatment

• Length of stay
• Charges
• Payer source

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VII. Measure and Predict Outcome at Follow-up

• Impairment
• Mortality
• Subsequent TBI

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VII. Measure and Predict Outcome at Follow-up

• Disability
• Disability Rating Scale (DRS)
• Functional Independence Measure (FIM)
• Glasgow Outcome Scale-Extended (GOS-E)
• Supervision Rating Scale (SRS)

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VII. Measure and Predict Outcome at Follow-up

• Participation
• Living with
• Residence (e.g., private home, SNF, AFC,
  hospital)
• Marital Status
• Level of education
• Employment
• Drug use
• Alcohol use (NHSDA/BRFSS)

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VII. Measure and Predict Outcome at Follow-up

• Participation (cont.)
• Transportation
• Income and source
• Arrests
• Psychiatric problems
• Patient Health Questionnaire (PHQ-9)
• Satisfaction with Life Scale (SWLS)
• Participation Assessment (PART)

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Sources of Data

• Abstract from medical records
• Pre-existing databases
• Specialized data collection forms
• Patient examination/interview/testing
• Family interview

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Guidelines for Follow-up

• Follow-up contact attempted with every patient
  1st, 2nd, 5th years and then every five year.
• 4 month window for year 1 follow-up, 6 month
  window for year 2, 1 year window for years 5, 10,
  15, . . .
• Patient is primary source of follow-up
  information if patient cannot be interviewed,
  follow-up is attempted with a proxy.
• Methods of follow-up in order of priority phone,
  mail questionnaire.

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TBIMS National DatabaseDescriptive Data
SummaryIncludes data from 01/01/1989
12/31/2007
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Age
mean 38.5 n 7899
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Gender
n 7897
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Race
n 7896
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Level of Education At Injury
n 7899
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Etiology of Injury
n 7872
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Blood Alcohol Level
At Emergency Department Admission
excludes cases not tested 20
mean 68.8 n 5856
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History of TBI
n 7790
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Glasgow Coma Scale Score
At Emergency Department Admission
mean 9.3 n 6048
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Duration of Unconsciousness
mean 9.5 days n 7545
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Duration of PTA
(Moderate/Severe)
(Extremely Severe)
(Very Severe)
mean 25.6 days n 5888
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Mean Length of Stay
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Mean Charges

• TOTAL CHARGES
• Acute 154,969
• Rehab. 56,901
• PER DIEM CHARGES
• Acute 7,779
• Rehab. 2,085
• 41 have government sponsored care (Mcaid/Mcare)

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Marital Status
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Living Situation
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Residence
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Employment Status
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Disability Rating Scale
Severe Disability
Moderate Disability
Partial Disability
Partial Disability
Partial Disability
Partial Disability
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Functional Independence Measure
Note The value of n is reflective of Total FIM
measure
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Functional Independence Measure
Mean Scores converted to 7-point scale
Complete Independence Modified Independence Superv
ision Minimal Assistance Moderate
Assistance Maximal Assistance Total Assistance
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Supervision Rating Scale
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Glasgow Outcome Scale-Extended
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Satisfaction With Life Scale
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How has the TBI Model Systems National Database
been used?

• Comparative analyses of sub-groups.
• Descriptive or predictive studies of outcomes.
• Comparison with other TBI populations.
• Comparison of TBI measures.

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How has the TBI Model Systems National Database
been used?
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How can NASHIA members use the TBI Model Systems
National Database?

• Benchmark comparisons on outcomes.
• Long-term outcomes can be used for state planning
  and advocacy.
• TBIMS database variables, measures, definitions,
  procedures can be used for other studies or
  purposes.
• Use summary data when need talking points about
  TBI.  
• Database available for research studies.

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Thank You!