title: Post-acute care referral and inpatient rehabilitation admission criteria for persons with brain injury across two Canadian provinces.
abstract: Investigate health care providers' perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces.
  
  
  
  Health care providers (n = 345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e.g., tracheostomy). The participants reported the perceived usefulness of referral/admission policies and assessment tools used.
  
  
  
  Ninety-one percent acute care and 98% rehabilitation participants reported the person with traumatic brain injury would likely or very likely be referred/admitted to rehabilitation compared to respectively 43% and 53% for the patient with hypoxia. Two additional factors significantly decreased the likelihood of referral/admission: older age and the combined presence of minimal learning ability, memory impairment and physical aggression. Some significant inter-provincial variations in the perceived referral/admission procedure were observed. Most participants reported policies were helpful. Similar assessment tools were used in acute care and rehabilitation.
  
  
  
  Health care providers appear to consider various factors when making decisions regarding referral and admission to rehabilitation. Variations in the perceived likelihood of referral/admission suggest a need for standardized referral/admission practices. Implications for Rehabilitation Various patient characteristics influence clinicians' decisions when selecting appropriate candidates for inpatient rehabilitation. In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury. Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.
authors.affiliation: a School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montréal , Québec , Canada.|b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Québec , Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Swaine
authors.affiliation: c Toronto Rehabilitation Institute , Ontario , Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
authors.affiliation: b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Québec , Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Messier
authors.affiliation: c Toronto Rehabilitation Institute , Ontario , Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.affiliation: d Centre hospitalier affilié universitaire de Québec, Pavillon Enfant-Jésus , Québec , Canada.
authors.forename: André
authors.initials: A
authors.lastname: Lavoie
authors.affiliation: e Ottawa Hospital, Rehabilitation Centre , Ontario , Canada.
authors.forename: Shawn
authors.initials: S
authors.lastname: Marshall
authors.affiliation: d Centre hospitalier affilié universitaire de Québec, Pavillon Enfant-Jésus , Québec , Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Sirois
authors.affiliation: d Centre hospitalier affilié universitaire de Québec, Pavillon Enfant-Jésus , Québec , Canada.
authors.forename: Alexis
authors.initials: A
authors.lastname: Turgeon-Fournier
authors.affiliation: c Toronto Rehabilitation Institute , Ontario , Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Lamoureux
authors.affiliation: a School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montréal , Québec , Canada.|b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Québec , Canada.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Lam Wai Shun
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology / Q000534:rehabilitation; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology / Q000534:rehabilitation*; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000458:organization & administration*; D010358:Patient Participation / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards*; D012307:Risk Factors; D019467:Subacute Care / Q000379:methods / Q000458:organization & administration; D014139:Tracheostomy / Q000534:rehabilitation* / Q000706:statistics & numerical data
keywords: Canada; Health services accessibility; brain injuries; decision making; neurological rehabilitation; patient selection