Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013

7/21/2019 Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013

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Association between fault status and patient-reportedoutcomes following orthopaedic trauma

Belinda Gabbe1, Pam Simpson1, David Attwood2, Greg Karstens2, David Gifford2, Melinda

Watt2, Alan Woodroffe2, Alex Collie1,3

1 Department of Epidemiology and Preventive Medicine, Monash University; 2 Transport Accident Commission; 3 Institute for

Safety Compensation and Recovery Research, Monash University



Background

• Numerous studies have observed poorer outcomes in

compensable patients compared to non-compensable

patients

• Attribution of fault or blame has been proposed as apotential explanatory factor for the differences

observed

• No clear consensus in the literature regarding the

impact of fault status on patient outcomes

2



Aim of the project

• Describe the association between fault status andpatient-reported outcomes

3



Methods

• Victorian Orthopaedic Trauma Outcomes Registry

(VOTOR)

– Sentinel site registry

– All orthopaedic trauma admissions >24h

– Routine telephone follow-up at 6-months and 12-months

• Linkage of VOTOR with Transport Accident Commission

(TAC) claims data

– Compensation Research Database (CRD) – Additional items directly from the TAC

• TAC cases from September 2010 to December 2011

4



Methods

Exposure of interest

• Fault status

– Police and self-report

– Categorised as

• Not at fault

• At fault

• Fault “in dispute”

Outcomes at 6 and 12-months

• Patient-reported

– SF-12 PCS and MCS scores

– GOS-E

– Pain

– Return to work

• TAC scheme costs

5



Data analysis

• Multivariable linear and logistic regression models

– Quantify association between fault status and outcome adjusted for key

potential confounders

– Covariates used included age, gender, nature of injury, level of education,

pre-injury work status, road user group and comorbid status

– Total TAC claim costs were log transformed for analysis

– Adjusted odds ratio (OR) and 95% CI for logistic models

– Adjusted mean difference and 95% CI for linear models

– Adjusted percentage change in the mean and 95% CI for cost models

6



Results

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N=1470 cases09/2010-12/2011

N=1290 with faultstatus recorded

N=571 At fault

N=578 Not at fault

N=141 In disputeN=117 missing faultstatus



Results – 6 month outcomes

8

Outcome at 6-months

Fault category N n (%) with

outcome

*AOR (95% CI) p-value

Good recovery At fault (reference) 514 176 (34.2) 1

In dispute 124 31 (25.0) 0.50 (0.30, 0.83) 0.01

Not at fault 523 159 (30.4) 0.70 (0.51, 0.95) 0.02

Complete recovery At fault (reference) 514 101 (19.7) 1

In dispute 124 15 (12.1) 0.48 (0.25, 0.92)

0.03

Not at fault 523 74 (14.2) 0.67 (0.46, 0.98)

0.04

Return to work At fault (reference) 391 241 (61.6) 1

In dispute 89 53 (59.6) 0.68 (0.39, 1.18) 0.17

Not at fault 380 218 (57.4) 0.67 (0.47, 0.95) 0.03

Moderate/severe pain At fault (reference) 436 101 (23.2) 1

In dispute 111 37 (33.3) 1.81 (1.11, 2.95)

0.02

Not at fault 445 121 (27.2) 1.20 (0.85, 1.70) 0.31




9

Outcome at 6-months

Fault category N Mean (sd) *Adjusted change

from no fault group

(95% CI)

p-value

PCS-12 At fault (reference) 397 39.9 (12.1) -

In dispute 98 37.3 (11.0) -3.2 (-5.7, -0.7) 0.01

Not at fault 401 37.0 (11.8) -3.0 (-4.7, -1.4) <0.001

MCS-12 At fault (reference) 397 50.8 (11.4) -

In dispute 98 48.1 (12.1) -2.7 (-5.3, -0.1) 0.04

Not at fault 401 49.9 (11.9) -1.1 (-2.9, 0.6) 0.20

Mean (sd) *Adjusted % change

from no fault group

(95% CI)

Cost At fault (reference) 570 56,167 (53,835) -

In dispute 139 55,651 (47,304) 8.1 (-8.5, 27.7) 0.36

Not at fault 573 61,250 (57,658) 11.4 (-0.1, 24.1) 0.05




10

Outcome at 12-months

Fault category N n (%) with

outcome

*AOR (95% CI) p-value

Good recovery At fault (reference) 484 194 (40.1) 1

In dispute 124 44 (35.5) 0.71 (0.45, 1.14) 0.16

Not at fault 494 168 (34.0) 0.65 (0.48, 0.89) 0.01

Complete recovery At fault (reference) 484 124 (25.6) 1

In dispute 124 20 (16.1) 0.41 (0.23, 0.75) 0.004

Not at fault 494 92 (18.6) 0.57 (0.39, 0.81) 0.002

Return to work At fault (reference) 365 255 (69.9) 1

In dispute 90 63 (70.0) 0.88 (0.49, 1.57) 0.66

Not at fault 353 244 (69.1) 0.85 (0.58, 1.25) 0.42

Moderate/severe pain At fault (reference) 392 107 (27.3) 1

In dispute 101 31 (30.7) 1.48 (0.88, 2.49) 0.14

Not at fault 400 109 (27.3) 1.12 (0.78, 1.60) 0.55




11

Outcome at 12-months

Fault category N Mean (sd) *Adjusted change

from no fault group(95% CI)

p-value

PCS-12 At fault (reference) 372 42.1 (12.8) -

In dispute 91 39.7 (11.5) -3.5 (-6.1, -0.8) 0.01

Not at fault 379 38.2 (11.9) -4.5 (-6.2, -2.7)

<0.001

MCS-12 At fault (reference) 372 50.1 (11.8) -

In dispute 91 47.0 (11.9) -3.8 (-6.5, -1.1) 0.01

Not at fault 379 49.0 (11.7) -1.6 (-3.4, 0.1) 0.07

Mean (sd) *Adjusted % change

from no fault group

(95% CI)

Cost At fault (reference) 330 65,614 (67,746) -

In dispute 92 62,052 (55,396) -1.8 (-21.9, 23.5) 0.88

Not at fault 298 75,587 (68,946) 10.9 (-5.9, 30.7) 0.22



Conclusions

• Fault status is an important predictor of functional and

quality of life outcomes

• “In dispute” cases demonstrated poorer mental health at 6

and 12-months post-injury than “At fault” cases • Future directions

– Larger sample for investigation

– Investigate the direction of the “in dispute” claims further

– Establish whether fault status accounts for differences between

compensable and non-compensable cases

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• “This project is funded by the Transport Accident

Commission, through the Institute for Safety,

Compensation and Recovery Research.”

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Acknowledgements

Association Between Fault Status and Patient-reported Outcomes Following Orthopaedic Trauma Belinda Gabbe ACHRF 2013

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