Grant: CIHR Fellowship

Nearly 10,000 persons are permanently or temporarily disabled each year in British Columbia due to injury. However, we do not know how frequently these patients are re-hospitalized after discharge and whether these re-hospitalizations could be prevented through improved access and utilization of outpatient support services. This limitation poses a serious deficiency to injury surveillance programs. I propose to study preventable re-hospitalizations following severe injury in British Columbia and the Yukon. My hypothesis is that reduced access and utilization of outpatient rehabilitative and psychological support services leads to increased rates of re-hospitalization. Furthermore, these risks will be higher among certain segments of the population, including women, patients who reside in rural and remote communities, and among populations with greater socio-economic disadvantage. I will test my hypothesis by estimating the adjusted odds ratios for re-hospitalization among injury survivors between 2001 and 2009, using linked administrative health, socio-economic, and geographic databases to build my analysis at the population-scale. I will administer an online survey of key stakeholders to identify which clinical indicators currently used to measure long-term functional outcomes can be reconstructed using linked administrative health databases. These stakeholders will include trauma surgeons, rehabilitation and return-to-work specialists, and medical health officers. The primary importance of this study is that it will recapture, for the first time, an entire trauma patient population since their initial discharge and assess whether current systems of care prevent re-hospitalization. This analysis will also identify where and among which populations increased re-hospitalization rates are occurring, thus providing a highly detailed population-wide perspective of barriers that delay reintegration back into work and society.