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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
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Belinda Gabbe - Monash University - Returning to work after traumatic injury

Sep 14, 2014

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Belinda Gabbe delivered the presentation at the 2014 Return to Work Forum.

The 2014 Return to Work Forum brought together speakers from multiple sectors to share best practice in return to work, injury management and rehabilitation.

For more information about the event, please visit: http://bit.ly/returntowork14
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Page 1: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 2: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 3: Belinda Gabbe - Monash University - Returning to work after traumatic injury

Serious injurySerious injury

28th February 2011Presentation title 3

Page 4: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 5: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 6: Belinda Gabbe - Monash University - Returning to work after traumatic injury

Victorian State Trauma Victorian State Trauma Registry

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Page 7: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 8: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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)

Page 9: Belinda Gabbe - Monash University - Returning to work after traumatic injury
Page 10: Belinda Gabbe - Monash University - Returning to work after traumatic injury

What are the return to work What are the return to work numbers?

28th February 2011Presentation title 10

Page 11: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 12: Belinda Gabbe - Monash University - Returning to work after traumatic 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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Page 13: Belinda Gabbe - Monash University - Returning to work after traumatic injury

Compensable status

7%4%

13

49%

40%

TAC

Medicare

WorkSafe

Private

Page 14: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 15: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 16: Belinda Gabbe - Monash University - Returning to work after traumatic injury

Return to organisation & role at 24-months

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Page 17: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 18: Belinda Gabbe - Monash University - Returning to work after traumatic injury

What do patients tell us?What do patients tell us?

28th February 2011Presentation title 18

Page 19: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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

Page 20: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 21: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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Page 22: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 23: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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Page 24: Belinda Gabbe - Monash University - Returning to work after traumatic injury

What have we learned?What have we learned?

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Page 25: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 26: Belinda Gabbe - Monash University - Returning to work after traumatic injury

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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Page 27: Belinda Gabbe - Monash University - Returning to work after traumatic injury

This project is funded by the Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery

Research (ISCRR).

Page 28: Belinda Gabbe - Monash University - Returning to work after traumatic injury

This project is proudly supported by the

Transport Accident Commission

Page 29: Belinda Gabbe - Monash University - Returning to work after traumatic injury