Do young people with neurological conditions in residential aged care use hospitals differently than those in the community? Evidence from Victorian hospital data, 2014-2017.

This study describes the duration and reasons for hospitalisation for three cohorts of younger adults with neurological conditions who either used residential aged care (RAC) or lived in the community. Hospitalisations as a clinical event indicate conditions for which younger people in RAC may need support as they move into community-based housing. Data describing 3 years of hospitalisations in Victorian public hospitals and emergency departments were used. The neurological conditions occurring among the three cohorts include (1) Cerebral Vascular Accident (CVA), (2) Traumatic Brain Injury (TBI) and (3) Multiple Sclerosis (MS). Frequency of hospitalisation, length of stay and leading causes of potentially preventable hospitalisations were examined. Two hundred and fifty-two (2.7%) of 9333 patients hospitalised for these neurological conditions subsequently used RAC. Hospitalisations were more frequent for those using RAC compared to those living in the community for cohorts with CVA and TBI (6.26 vs. 2.65 events per person-year for CVA and 4.34 vs. 1.88 for TBI) while hospitalisations were more frequent among those in the community compared to those using RAC for the cohort living with MS (3.62 vs. 5.35 per person-year). However, for all the cohorts, the average length of acute hospital stays was longer among RAC users than among those in the community (19.6 vs. 6.2 days for CVA, 15.5 vs. 4.5 for TBI and 12.2 vs. 7.0 for MS). Leading causes for hospitalisation were complex comorbidities and changes in health status (such as seizures, ulcers, dehydration and cellulitis). Efforts should be made to design supports and proactively manage health needs leading to these hospitalisations.

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

OBJECTIVE: To investigate a model of community-based case management (CM). SETTING: New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). PARTICIPANTS: All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. DESIGN: A prospective, multicenter study. MAIN MEASURES: A purpose-designed survey. METHODS: Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). RESULTS: All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. CONCLUSION: The NSW BIRP has drawn upon the results to produce a model of service for CM.

The provision of brain injury rehabilitation services for people living in rural and remote New South Wales, Australia.

OBJECTIVES: The objectives of this research were to investigate the equity of brain injury rehabilitation services to rural and remote areas of the state of New South Wales (NSW), Australia, and to describe the experience of people who access and who deliver these services. METHODS: Semi-structured interviews were used to gather information from people with acquired brain injury (ABI), their families and rural and remote NSW health, rehabilitation and support services staff who worked with people with a brain injury. Data analysis was guided by an interpretative phenomenological analysis approach. FINDINGS: Fifty-nine service providers representing 35 organizations, six people with ABI and seven family members participated in the research. Three key issues emerged from the data: (1) Limited access to appropriate brain injury rehabilitation; (2) Difficulties funding, recruiting and retaining appropriately skilled health, rehabilitation and support staff; and (3) Inadequate current services resulting in a number of unmet needs. CONCLUSION: Current models of practice for ABI rehabilitation are not appropriate to address the significant inequalities and gaps in available services for people with brain injury in rural and remote NSW. Alternative innovative models are needed to reduce the disparity of access and outcomes for these people.

Outcomes of participation objective, participation subjective (POPS) measure following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the participation of adults living with traumatic brain injury in regional and rural NSW as measured by the Participation Objective Participation Subjective (POPS) measure. RESEARCH DESIGN: A quantitative survey of a single cohort as the first of a two phase mixed methods study. METHODS AND PROCEDURES: One hundred and thirty-one adults with a TBI were recruited through eight rural brain injury rehabilitation programmes in NSW. These adults completed a range of survey instruments, including the POPS. MAIN OUTCOMES AND RESULTS: The POPS measure supported findings from other research that identified varying impacts of TBI. However, in contrast to other studies, there was no correlation between participation scores and age, gender, time since injury and severity of injury. CONCLUSIONS: The findings from this study suggest that the issue of participation of adults with TBI living in non-metropolitan areas needs to be further researched.