A look at policy surrounding long-term neurorehabilitation for people with acquired brain injury in Alberta
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2018-09-11
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Abstract
In Alberta, there is an inadequate amount of community and outpatient neurorehabilitation services available to support the growing number of individuals who suffer from acquired brain injury (ABI). ABI is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Many individuals with ABI become dependent on costly health and social services, resulting in high-expenses for Alberta. Even though ABI is a growing concern for Alberta, no provincial policy strategy has been put in place to ensure Albertan’s get timely access to community and outpatient rehabilitation programs after being discharged from acute care and inpatient rehabilitation. Instead, many individuals either wait a long time before being admitted to important rehabilitation programs or they never receive treatment at all. A reason for a lack of policy can be attributed to how there is limited research in Alberta that looks at the overall benefits of community-based neurorehabilitation programs. Therefore, the overall policy recommendation is that the provincial government should establish a comprehensive and province-wide study that looks at the effectiveness and benefits associated with community neurorehabilitation programs in Alberta. To accomplish this study, Alberta should fund additional community neurorehabilitation programs to the ones already in existence so that more individuals with ABI can be included. The results of this study came from the analysis of data from a rehabilitation centre located in Alberta called the Association for the Rehabilitation of the Brain Injury (ARBI). The purpose of the analysis was to determine if there was an overall significant improvement for clients in terms of health outcomes and quality of life after undertaking community neurorehabilitation. In addition to improved health outcomes, cost of care based on place of residence at admission, discharge and follow-up was analyzed to determine if rehabilitation is a cost-effective solution to the growing ABI health crisis. First, the costs of care were determined by looking at the costs associated with four different residence categories including one’s own home, the hospital and two living support services under Alberta’s continuing care system for individuals with ABI. These living support services include personal care home (PCH) and long-term care (LTC). The costliest place of residence was determined to be the hospital, followed by LTC, PCH and own-home in that order. Depending on the severity of disability, individuals may need more support and thus reside in a more expensive place of residence, proving costly for Alberta. Next, the cost of care data was analyzed by comparing two different cases, case 1 and case 2. Case 1 represented client’s undergoing rehabilitation at ARBI and case 2 represented the situation where clients did not go to ARBI. First, the two cases were compared to see if there was statistical significance, and then the calculated difference between case 1 and case 2 was compared to the cost of rehabilitation at ARBI. The results of this study found there to be both a clinically significant and statistically significant improvement for client’s in different areas of impairment, suggesting that community neurorehabilitation positively improves health and social outcomes for individuals with ABI. Additionally, the cost of care results found there to be positive cost savings associated with undergoing rehabilitation at ARBI. The total cost of case 1 and case 2 was calculated to be $11,377,800 and $17,980,950.00, respectively for an overall cost savings of $6,603,150.00 or $194,210.29 per person over 65 months. When the cost of ARBI was added to case 1, there was still an overall cost savings of $5,637,550.00, or $165,810.29 per person over 65 months. Overall, the results of this study indicate that the Government of Alberta only needs to help a few individuals through neurorehabilitation programs like ARBI to experience substantial gains. Therefore, the overall policy recommendation is based on the results of this study, as well as from other research studies, that found community neurorehabilitation to be a critical next step in the recovery of individuals with ABI. Community neurorehabilitation is a multidisciplinary approach that combines specialized clinical and social supports to deliver an individualized and evidence-based pathway of care. ABI can have a lot of different negative impacts on an individual, and so a multidisciplinary approach is important. This study, along with other research has shown that timely access to equitable and intensive multidisciplinary neurorehabilitation services can improve patient outcomes and quality of life while also reducing an individual’s reliance on health and social services. Therefore, the overall policy recommendation is based on how Alberta needs to take more action to fully understand how to best help individuals with ABI while also reducing the burden on government health and social services.
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Ryan, S. (2018). A look at policy surrounding long-term neurorehabilitation for people with acquired brain injury in Alberta (Unpublished master's project). University of Calgary, Calgary, AB.