June 11, 2020
The Ontario Neurotrauma Foundation has released a new report titled, Ontario and Sub Regional Traumatic Brain Injury (TBI) Care Report Cards and Provincial and Regional Trends. This report provides key insights into the current landscape of publicly funded TBI care in Ontario and issues the first of its kind TBI Report Card.
The TBI Report Card was developed in collaboration with partners from Toronto’s University Health Network (UHN) and ICES (formerly Institute for Clinical Evaluative Sciences). With data gathered from ICES, this resource developed to inform healthcare policy makers and planners, illustrates the trends related to publicly funded TBI care in Ontario from 2012/13 to 2017/18. Currently there is no other resource that uses key indicators for TBI rehabilitation to assist regional or provincial teams better understand trends in outcomes of care and, guide improvements in care that can also reduce healthcare and system costs.
The intended users of the tool are Ontario Health, the five interim Health Regions, ABI Navigators as well as the developing Ontario Health Teams, the Ontario Ministry of Health and other health services and planning groups. Understanding the trends within TBI care in Ontario, healthcare policy makers and program planners will be better informed make care plan and system adjustments to improve overall outcomes based on the evidence-based indicators.
TBI Report Card presents eleven evidence-based key performance indicators that characterize the provincial and regional TBI landscape across the prevention, acute management, rehabilitation, and reintegration continuums of care. The findings of the report emphasize the need for a continued effort towards quality improvement and equitable access to TBI care given disparities between rural and urban LHINs.
The idea for the Report Card emerged during the development of the third edition of the ONF TBI Guideline released in 2018. UHN-TRI (Toronto Rehab Institute) Physiatrist-in-Chief & Program Medical Director, Dr. Mark Bayley who also sits as Chair of the ONF ABI Committee, participated in the development of the Stroke Report Card and suggested ONF establish a TBI Report Card. ONF’s Data Advisory Committee has offered input and context for the data analysis. The ONF ABI Committee as well as brain injury stakeholder organization partners were also consulted along the way to ensure the ABI community voice was part of the process.
Ultimately a panel of provincial health system and clinical experts collaborated in the development of this report as well as the creation of fourteen practical recommendations to address the major inefficiencies identified in the report card. The findings from this report align directly with the Ontario Ministry of Health’s current mandates to improve access to care and enhance system efficiency through effective organization. Individuals with resource or organizational tools at their disposal should reference the TBI Report Card to help identify areas under their purview which fall below the provincial average and help facilitate an evidence-based response to these findings.
Facts about TBI care in Ontario
- TBI is often a life-long condition resulting in physical, cognitive and psychological impairments; however early and evidence-based interventions can support TBI recovery.
- Data shows that incidence of admission for TBI and mortality associated with TBI are increasing in Ontario.
- Once admitted to acute care, 25-30% of days are spent in an alternate level of care, meaning individuals are occupying beds above the care needs, which is a misuse of Ontario health resources.
- There are significant barriers and delays in access to care and patient follow-up in rural and northern regions, with some experiencing wait times that are three times longer than the province average.
- Less than 20% of patients with TBI are admitted to inpatient rehabilitation following acute care.
The inaugural TBI Report Card identifies trends in the 2013–2018 fiscal year period. For next year, the indicators will be reviewed to reflect 2018/19 and 2019/20, going forward this review will be completed on an annual basis. Small adjustments and updates to the Report Card may be made to ensure its ongoing relevance and support for changes to TBI care and consistency with the ONF living evidence-based best practice guidelines for TBI rehabilitation.