Returning to work after serious traumatic injury Professor Belinda Gabbe Head of Prehospital, Emergency and Trauma Research School of Public Health and Preventive Medicine Head of Prehospital, Emergency and Trauma Research
Sep 14, 2014
Returning to work after serious traumatic injuryProfessor Belinda GabbeHead of Prehospital, Emergency and Trauma Research
School of Public Health and Preventive Medicine
Head of Prehospital, Emergency and Trauma Research
Overview of the presentation
1. Placing serious injury in the context of the wider injury population
2. Introduce the Victorian State Trauma Registry2. Introduce the Victorian State Trauma Registry
3. Provide the numbers
4. Discuss patient experiences with return to work
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Serious injurySerious injury
28th February 2011Presentation title 3
Injury Pyramid
Incre
asin
g s
everi
ty
Deaths
Major trauma
Other hospital admissions
Incre
asin
g f
req
uen
cy
Incre
asin
g s
everi
ty
Emergency Department visits
Specialists
Community-based professionals
(GP, physiotherapists, chiropractors, podiatrists, etc)
First aid providers
Pharmacies, self-treatment, no treatment
Incre
asin
g f
req
uen
cy
Serious injury is life changing event
Seriously injured patients often require prolonged treatment and rehabilitation, and access to disability services
Consequences of injury are many and varied
Potential for prolonged and lifelong disability Potential for prolonged and lifelong disability
Employment and economic impacts are common
– Prolonged absences from work
– Risk of substantial financial burden
Complex funding of injury treatment and rehabilitation
– TAC, WSV, Medicare, DVA, Private health insurance
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Victorian State Trauma Victorian State Trauma Registry
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Victorian State Trauma Registry
Population-based trauma registry, integrated into the state’s trauma system
Receives data from all 138 trauma-receiving hospitals in the state
Uses an opt-off consent process
Collecting data since July 2001 Collecting data since July 2001
Data collected includes pre-hospital (ambulance), all acute hospital admissions, and post-discharge outcomes
Unique registry due to the focus on all phases of care and the routine collection of long term functional, quality of life and return to work outcomes
VSTR routine follow-up
Focus on brief, validated, inexpensive instruments where formal training or accreditation not required
Centralised location for follow-up and trained interviewers
6-months, 12-months and 24-months post-injury
Adult cases Adult cases
– GOS-E, global measure of function
– SF-12 and EQ-5D, generic measures of health-related quality of life
– Pain
– Pre-injury work status and occupation, and return to work
Linkage with the deaths registry
(Gabbe et al. J Trauma 2010;69:532-536)
What are the return to work What are the return to work numbers?
28th February 2011Presentation title 10
7135
major trauma patients
Jul 2007-Dec 2011
18-64 years of age
7135
major trauma patients
Jul 2007-Dec 2011
18-64 years of age
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468 (7%) in-hospital deaths
468 (7%) in-hospital deaths
6667 (93%) survivors to discharge
6667 (93%) survivors to discharge
79% working for income prior to the injury
79% working for income prior to the injury
Profile of major trauma patientsCharacteristic
Age Mean (SD) years 37.1 (13.6)
Sex Male 81%
Injury Severity Score Median (IQR) 17 (14-24)
Type of injury Multi-trauma (no neurotrauma)Head and other injuries
44%25 %Head and other injuries
Isolated head injuryOrthopaedic injuries onlyChest/abdominal injuriesSpinal cord
25 %11%11%6%3%
Injury intent Unintentional 88%
Cause of injury Motor vehicleMotorcycleHigh fallStruck by/collision withLow fallPedal cyclist
29%17%11%11%7%7%
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Compensable status
7%4%
13
49%
40%
TAC
Medicare
WorkSafe
Private
Occupation group
32%
9%
5%3%
Tradespersons
Professionals
Production and transport workers
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13%
13%
13%
10%
workers
Clerical/sales/service workers
Associate professionals
Managers and administrators
Self-employed - NFS
Labourers and related workers
Return to work by occupation group
30
40
50
60
70
80
90
% r
etu
rne
d t
o w
ork
15
0
10
20
30
% r
etu
rne
d t
o w
ork
6-months
12-months
24-months
Return to organisation & role at 24-months
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Key predictors of return to work Women have 50% lower adjusted odds of RTW
Odds of RTW decline 4% with each increased year of age
Improved odds of return to work with time since injury
Type and severity of injury impacts on likelihood of return to work
80% lower odds of RTW if intentional self-harm and 65% lower if an 80% lower odds of RTW if intentional self-harm and 65% lower if an assault victim
TAC and WorkSafe patients have 80% lower odds of RTW than non-compensable patients
Higher odds of RTW with better levels of education, managerial, professional and associate professional roles compared with tradespersons
Independent of occupation and other factors, higher SES associated with much higher odds of RTW
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What do patients tell us?What do patients tell us?
28th February 2011Presentation title 18
Qualitative study
• In-depth personal interviews of 120 trauma survivors
• Recorded via telephone
• Adult, blunt trauma patients
• 1 to 2 years post-injury• 1 to 2 years post-injury
• Purposeful quota sampling
• 60 of each gender, major trauma hospital, and compensable status evenly represented across age groups
• Topic guide
• Interviews transcribed and coded
• Thematic coding frame applied to coded text
Financial burden is common
81% reported financial implications
Issue for working age patients caused by prolonged inability to work
Patients with less time at their place of employment vulnerable
Reliance on savings and loans from family members/friends
Careful budgeting required
TAC patients largely protected but doesn’t cover full salary and other implications of receiving TAC loss of earnings payments
Income protection insurance valued by those that had it
Work impacts extend beyond the patient
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Perceptions of return to work Most reported their injury negatively impacted on work
Positive support from the employer or workplace crucial
– Use of sick, annual and long service leave– Providing a “back to work” program– Able to perform alternative duties– Additional financial support– Additional financial support
Barriers to return to work
– Employer not listening to needs or having unrealistic expectations– Employer not understanding physical limitations– Employer ignoring GP recommendations for the worker– Employer failing to approve sick leave– Inability to access retraining at all or inappropriate retraining
Missed job opportunities and promotions while recovering
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What have we learned?What have we learned?
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Seriously injured patients of working age
– Predominantly male– Road trauma dominates– TAC and Medicare primary funders– Half have manual jobs
29% not returned to work at 2 years
30% have changed workplace or organisation 30% have changed workplace or organisation
If return to same workplace, 89% resume the same role
Vulnerable patients with lower odds of return to work
– Age, gender, injury intent, compensable status, SES, occupation, injury type
Particular patient groups at high risk of substantial financial impact
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Closing comments
Return to work important for economic, psychosocial and physical reasons
Facilitating return to work clearly needed and workplace/employer support critical in the process
Job retraining and return to work programs important but many patients Job retraining and return to work programs important but many patients do not meet the criteria for commonwealth work rehabilitation programs and opportunities limited particularly where not in the compensation system
Improved access to return to work services needed
TAC and compensation schemes, and supportive workplaces, limit financial burden
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This project is funded by the Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery
Research (ISCRR).
This project is proudly supported by the
Transport Accident Commission