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1.  Acute Care Alternate-Level-of-Care Days Due to Delayed Discharge for Traumatic and Non-Traumatic Brain Injuries 
Healthcare Policy  2012;7(4):41-55.
Alternate-level-of-care (ALC) days represent hospital beds that are taken up by patients who would more appropriately be cared for in other settings. ALC days have been found to be costly and may result in worse functional outcomes, reduced motor skills and longer lengths of stay in rehabilitation. This study examines the factors that are associated with acute care ALC days among patients with acquired brain injury (ABI). We used the Discharge Abstract Database to identify patients with ABI using International Classification of Disease-10 codes. From fiscal years 2007/08 to 2009/10, 17.5% of patients with traumatic and 14% of patients with non-traumatic brain injury had at least one ALC day. Significant predictors include having a psychiatric co-morbidity, increasing age and length of stay in acute care. These findings can inform planning for care of people with ABI in a publicly funded healthcare system.
PMCID: PMC3359084  PMID: 23634162
2.  Living Environments for People with Moderate to Severe Acquired Brain Injury 
Healthcare Policy  2010;5(4):e120-e138.
Objectives:
This study examines the issue of living environments for persons with acquired brain injury (ABI), with the aim of identifying factors that enable or act as barriers to appropriate living environments.
Methods:
A qualitative study involving 31 semi-structured interviews conducted with 56 key informants representing various relevant sectors: institutional, community, residential and non-residential, consumer/advocacy and government/policy from six regions in the province of Ontario, Canada.
Results:
The study identified such barriers as lack of ABI-specific facilities, beds and trained staff and a poorly coordinated system in many areas, with long wait lists for specialized residential settings. Clients with ABI need individualized treatment, making development of a standardized model of care difficult, particularly for those with co-morbid conditions. Solutions such as more flexible options for clients and better trained staff emerged.
Conclusions:
The study presents solutions to challenges and limitations in addressing appropriate living environments for persons with ABI.
PMCID: PMC2875897  PMID: 21532762

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