Impact of problematic behaviors on patient and healthcare system outcomes: A survey of brain-injury providers

Research Objectives: Examine patient and healthcare system outcomes of challenging behavior following brain-injury. Compare and contrast outcomes by treatment setting and perceived team effectiveness.

Design: Cross-sectional study of anonymous provider responses to a national survey.

Setting: Inpatient and outpatient treatment centers.

Participants: Respondents (N=302) included behavioral health providers (52%), medical providers (18%), and rehabilitation therapists (30%). Majority of providers work with adults (95%) in inpatient settings (62%).

Interventions: N/A

Main Outcome Measures: Patient and healthcare system outcomes.

Results: The most frequently endorsed patient outcomes impacted by challenging behaviors were: limited options for discharge placement (91%), poor therapy engagement (90%), interference with ADL care delivery (86%), and increased LOS (85%). Top endorsed system outcomes were increased number of staff (85%) and increased staff burn out (81%). Sensitivity analyses revealed inpatient providers were more likely to report patient injuries (X2 (1, N=276) =7.5, p=.006), staff turnover (X2 (1, N=273) =4.1, p=.04), increased number of staff needed (X2 (1, N=275) =26.6, p=.00), and staff injuries (X2 (1, N=276) =10.7, p =.001) compared to outpatient providers. When stratified by self-rated program effectiveness (not effective, effective, very effective), respondents differed in patient therapy engagement (X2 (2, N=280) =6.4, p=.04), staff turnover (X2 (2, N=273) =10.7, p=.005) and staff burn out (X2 (2, N=276) =8.8, p=.01).

Conclusions: Findings highlight the adverse impact of brain-injury related behaviors on patient and healthcare-system outcomes. Despite the prevalence of findings across providers and setting types, there is a paucity of evidence-based protocols available to treatment providers. The current findings point to distinct patient and healthcare system intervention targets that will help inform the development of effective treatment protocols aimed at managing brain-injury related challenging behaviors.

Author(s) Disclosures: Authors have no conflict of interest to disclose. Material is the result of work supported with resources at James A. Haley Veterans’ Hospital. Views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the Department of VA,, Defense Health Agency, Department of Defense, or any other U.S. government agency.