{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:09:03Z","timestamp":1769818143157,"version":"3.49.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2012,8,17]],"date-time":"2012-08-17T00:00:00Z","timestamp":1345161600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer\u2019s perspective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2377-12-76","type":"journal-article","created":{"date-parts":[[2012,8,17]],"date-time":"2012-08-17T20:14:02Z","timestamp":1345234442000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Direct cost associated with acquired brain injury in Ontario"],"prefix":"10.1186","volume":"12","author":[{"given":"Amy","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ksenia","family":"Bushmeneva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Zagorski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Colantonio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter P","family":"Wodchis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2012,8,17]]},"reference":[{"issue":"3 Suppl 1","key":"681_CR1","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1053\/apmr.2003.50052","volume":"84","author":"MA Greenwald BD DM Burnett Miller","year":"2003","unstructured":"Greenwald BD DM Burnett Miller MA: Congenital and Acquired Brain Injury. Brain Injury: Epidemiology and Pathophysiology. Arch Phys Med Rehabil. 2003, 84 (3 Suppl 1): S3-7.","journal-title":"Arch Phys Med Rehabil"},{"key":"681_CR2","volume-title":"Neurological Disorders","author":"World Health Organization","year":"2006","unstructured":"World Health Organization: Neurological Disorders. 2006, Geneva: Public Health Challenges"},{"key":"681_CR3","unstructured":"ABI Network: Definition of \u201cAcquired Brain Injury\u201d. http:\/\/www.abinetwork.ca\/downloads\/abidefinition.pdf. Accessed: June 15 2012"},{"key":"681_CR4","volume-title":"Traumatic brain injury in the United States: A report to Congress","author":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control","year":"1999","unstructured":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Traumatic brain injury in the United States: A report to Congress. 1999, [http:\/\/www.cdc.gov\/traumaticbraininjury\/tbi_report_to_congress.html] Accessed April 5 2011"},{"key":"681_CR5","volume-title":"Traumatic Brain Injury in the United States: Emergency Departments Visits Hospitalizations and Deaths 2002\u20132006","author":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control","year":"2010","unstructured":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Traumatic Brain Injury in the United States: Emergency Departments Visits Hospitalizations and Deaths 2002\u20132006. 2010, [http:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/blue_book.pdf] Accessed April 5 2011"},{"key":"681_CR6","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1136\/bmj.331.7530.1419","volume":"331","author":"S Fleminger","year":"2005","unstructured":"Fleminger S, Ponsford J: Long term outcome after traumatic brain injury. BMJ. 2005, 331: 1419-1420. 10.1136\/bmj.331.7530.1419.","journal-title":"BMJ"},{"key":"681_CR7","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1136\/bmj.320.7250.1631","volume":"320","author":"S Thornhill","year":"2000","unstructured":"Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI: Disability in young people and adults one year after head injury: prospective cohort study. BMJ. 2000, 320: 1631-1635. 10.1136\/bmj.320.7250.1631.","journal-title":"BMJ"},{"issue":"11","key":"681_CR8","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1080\/026990596123945","volume":"10","author":"JH Olver","year":"1996","unstructured":"Olver JH, Ponsford JL, Curran CA: Outcome following traumatic brain injury: a comparison between 2 and 5\u2009years after injury. Brain Inj. 1996, 10 (11): 841-848. 10.1080\/026990596123945.","journal-title":"Brain Inj"},{"issue":"12","key":"681_CR9","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1016\/S0003-9993(97)90303-8","volume":"78","author":"JM Mazaux","year":"1997","unstructured":"Mazaux JM, Masson F, Levin HS, Alaoui P, Maurette P, Barat M: Long-term neuropsychological outcome and loss of social autonomy after traumatic brain injury. Arch Phys Med Rehabil. 1997, 78 (12): 1316-1320. 10.1016\/S0003-9993(97)90303-8.","journal-title":"Arch Phys Med Rehabil"},{"issue":"6","key":"681_CR10","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1097\/00001199-200012000-00003","volume":"15","author":"A Hodgkinson","year":"2000","unstructured":"Hodgkinson A, Veerabangsa A, Drane D, McCluskey A: Service utilization following traumatic brain injury. J Head Trauma Rehabil. 2000, 15 (6): 1208-1226. 10.1097\/00001199-200012000-00003.","journal-title":"J Head Trauma Rehabil"},{"key":"681_CR11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/01.PHM.0000154896.55045.E7","volume":"84","author":"SJ Vangel","year":"2005","unstructured":"Vangel SJ, Rapport LJ, Hanks RA, Black KL: Long-term medical care utilization and costs among traumatic brain injury survivors. Am J Phys Med Rehabil. 2005, 84: 153-160. 10.1097\/01.PHM.0000154896.55045.E7.","journal-title":"Am J Phys Med Rehabil"},{"key":"681_CR12","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/00001199-200405000-00003","volume":"19","author":"VL Phillips","year":"2004","unstructured":"Phillips VL, Greenspan AI, Stringer AY, Stroble AK, Lehtonen S: Severity of injury and service utilization following traumatic brain injury: The first 3\u2009months. J Head Trauma Rehabil. 2004, 19: 217-225. 10.1097\/00001199-200405000-00003.","journal-title":"J Head Trauma Rehabil"},{"key":"681_CR13","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1080\/02699050802060621","volume":"22","author":"CM Cameron","year":"2008","unstructured":"Cameron CM, Purdie DM, Kliewer EV, McClure RJ: Ten-year outcomes following traumatic brain injury: A population-based cohort. Brain Inj. 2008, 22: 437-449. 10.1080\/02699050802060621.","journal-title":"Brain Inj"},{"key":"681_CR14","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/S0140-6736(00)02689-1","volume":"356","author":"J Ghajar","year":"2000","unstructured":"Ghajar J: Traumatic Brain Injury. Lancet. 2000, 356: 923-929. 10.1016\/S0140-6736(00)02689-1.","journal-title":"Lancet"},{"key":"681_CR15","unstructured":"Canadian Institute of Health Information: NRS length of stay and length of stay efficiency of inpatient rehabilitation clients. http:\/\/www.cihi.ca\/CIHI-ext-portal\/internet\/EN\/Quick_Stats\/quick+stats\/quick_stats_main?xTopic=Hospital%20Care&pageNumber=2&resultCount=20&filterTypeBy=0&filterTopicBy=5&autorefresh=1#. Accessed April 5 2011"},{"key":"681_CR16","volume-title":"The Burden of Neurological Diseases, Disorders and Injuries in Canada","author":"Canadian Institute of Health Information","year":"2007","unstructured":"Canadian Institute of Health Information: The Burden of Neurological Diseases, Disorders and Injuries in Canada. 2007, Ottawa: CIHI, https:\/\/secure.cihi.ca\/free_products\/BND_e.pdf] Accessed April 10, 2011"},{"issue":"12","key":"681_CR17","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1097\/00005373-198812000-00004","volume":"28","author":"JF Kraus","year":"1988","unstructured":"Kraus JF, Nourjah P: The epidemiology of mild uncomplicated brain injury. J Trauma. 1988, 28 (12): 1637-1643. 10.1097\/00005373-198812000-00004.","journal-title":"J Trauma"},{"issue":"5","key":"681_CR18","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1097\/00001199-200409000-00005","volume":"19","author":"I Brener","year":"2004","unstructured":"Brener I, Harman JS, Kelleher KJ, Yeates KO: Medical costs of mild to moderate traumatic brain injury in children. J Head Trauma Rehabil. 2004, 19 (5): 405-412. 10.1097\/00001199-200409000-00005.","journal-title":"J Head Trauma Rehabil"},{"issue":"2","key":"681_CR19","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/00005373-199602000-00007","volume":"40","author":"AK Ommaya","year":"1996","unstructured":"Ommaya AK, Ommaya AK, Dannenberg AL, Salazar AM: Causation incidence and costs of traumatic brain injury in the U.S. military medical system. J Trauma. 1996, 40 (2): 211-217. 10.1097\/00005373-199602000-00007.","journal-title":"J Trauma"},{"issue":"4","key":"681_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00001199-199508000-00002","volume":"10","author":"CA Brooks","year":"1995","unstructured":"Brooks CA, Lindstrom J, McCray J, Whiteneck GG: Cost of medical care for a population-based sample of persons surviving traumatic brain injury. J Head Trauma Rehabil. 1995, 10 (4): 1-13. 10.1097\/00001199-199508000-00002.","journal-title":"J Head Trauma Rehabil"},{"issue":"1","key":"681_CR21","doi-asserted-by":"publisher","first-page":"S84","DOI":"10.1007\/s10198-005-0293-2","volume":"5","author":"J Berg","year":"2004","unstructured":"Berg J: Economic evidence in trauma: a review. Eur J Health Econom. 2004, 5 (1): S84-S91. 10.1007\/s10198-005-0293-2.","journal-title":"Eur J Health Econom"},{"issue":"1","key":"681_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1468-1331.2005.01202.x","volume":"12","author":"P Andlin-Sobocki","year":"2005","unstructured":"Andlin-Sobocki P, J\u00f6nsson B, Wittchen HU, Olesen J: Cost of disorders of the brain in Europe. Eur J of Neurology. 2005, 12 (1): 1-27. 10.1111\/j.1468-1331.2004.01019.x.","journal-title":"Eur J of Neurology"},{"key":"681_CR23","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1097\/00005373-200212000-00020","volume":"53","author":"LJ McGarry","year":"2002","unstructured":"McGarry LJ, Thompson D, Millham FH, Cowell L, Snyder PJ, Lenderking WR, Weinstein MC: Outcomes and costs of acute treatment of traumatic brain injury. J Trauma. 2002, 53: 1152-1159. 10.1097\/00005373-200212000-00020.","journal-title":"J Trauma"},{"key":"681_CR24","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/003335490912400412","volume":"124","author":"NA Kayani","year":"2009","unstructured":"Kayani NA, Homan S, Yun S, Zhu BP: Health and economic burden of traumatic brain injury: Missouri 2001\u20132005. Public Health Rep. 2009, 124: 551-560.","journal-title":"Public Health Rep"},{"key":"681_CR25","volume-title":"Canadian Institute for Health Information Discharge Abstract Database: A validation study","author":"D Juurlink","year":"2006","unstructured":"Juurlink D, Preyra C, Croxford R, Chong A, Austin P, Tu J, Laupacis A: Canadian Institute for Health Information Discharge Abstract Database: A validation study. 2006, Toronto: Toronto Institute for Clinical Evaluative Sciences"},{"key":"681_CR26","unstructured":"Canadian Institute of Health Information: National Rehabilitation Reporting System (NRS). http:\/\/secure.cihi.ca\/cihiweb\/en\/downloads\/NRS_Update_dec2005_e.pdf] Accessed April 5 2011"},{"issue":"8","key":"681_CR27","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1097\/MLR.0b013e3181789471","volume":"46","author":"WP Wodchis","year":"2008","unstructured":"Wodchis WP, Naglie G, Teare GF: Validating Diagnostic Information on the Minimum Data Set in Ontario Hospital-Based Long-Term Care. Medical Care. 2008, 46 (8): 882-887. 10.1097\/MLR.0b013e3181789471.","journal-title":"Medical Care"},{"key":"681_CR28","unstructured":"Ministry of Health and Long-Term Care Health Data Branch. http:\/\/www.mohltcfim.com. Accessed April 5 2011"},{"key":"681_CR29","unstructured":"Ontario Joint Policy and Planning Committee: Development of rehabilitation patient groups (RPG) case mix classification methodology and weighting system for adult impatient rehabilitation. https:\/\/ospace.scholarsportal.info\/bitstream\/1873\/1253\/1\/268600.pdf] Accessed April 5 2011"},{"key":"681_CR30","volume-title":"Ontario Neurotrauma Foundation","author":"A Colantonio","year":"2009","unstructured":"Colantonio A, Parsons D, Vander Laan R, Zagorski B: Ontario Neurotrauma Foundation. 2009, Toronto: ABI Dataset Pilot Project Phase 1 Report"},{"key":"681_CR31","volume-title":"Primary Care Compensation Models","author":"S Wooder","year":"2011","unstructured":"Wooder S: Primary Care Compensation Models. 2011, Hamilton, Ontario: HNHB Board Presentation, http:\/\/www.hnhblhin.on.ca\/uploadedFiles\/Public_Community\/Board_of_Directors\/Board_Meeting\/Primary%20Care%20Compensation%20Models%20-%20LHIN%20Presentation%20-%20Wooder-FINAL%20revised.pdf. Accessed November 10, 2011"},{"issue":"10","key":"681_CR32","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1503\/cmaj.109-3068","volume":"181","author":"R Collier","year":"2009","unstructured":"Collier R: Shift toward capitation in Ontario. CMAJ. 2009, 181 (10): 668-669. 10.1503\/cmaj.109-3068.","journal-title":"CMAJ"},{"key":"681_CR33","volume-title":"National Health Expenditure Trends 1975 to 2011","author":"Canadian Institute of Health Information","year":"2011","unstructured":"Canadian Institute of Health Information: National Health Expenditure Trends 1975 to 2011. 2011, Ottawa, Ont: CIHI, https:\/\/secure.cihi.ca\/free_products\/nhex_trends_report_2011_en.pdf. Accessed April 10, 2011"},{"issue":"12","key":"681_CR34","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1155\/2010\/569692","volume":"24","author":"M Krajden","year":"2010","unstructured":"Krajden M, Kuo M, Zagorski B, Alvarez M, Yu A, Krahn M: Health care costs associated with hepatitis C: a longitudinal cohort study. Can J Gastroenterol. 2010, 24 (12): 717-726.","journal-title":"Can J Gastroenterol"},{"issue":"3","key":"681_CR35","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1111\/j.1464-410X.2009.08758.x","volume":"105","author":"MD Krahn","year":"2010","unstructured":"Krahn MD, Zagorski B, Laporte A, Alibhai SM, Bremner KE, Tomlinson G, Warde P, Naglie G: Healthcare costs associated with prostate cancer: estimates from a population-based study. BJU Int. 2010, 105 (3): 338-346. 10.1111\/j.1464-410X.2009.08758.x.","journal-title":"BJU Int"},{"issue":"1","key":"681_CR36","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1471-2377-12-16","volume":"12","author":"AY Chen","year":"2012","unstructured":"Chen AY, Zagorski B, Parsons D, Vander Laan R, Chan V, Colantonio A: Factors associated with discharge destination from acute care after acquired brain injury in Ontario Canada. BMC Neurol. 2012, 12 (1): 16-10.1186\/1471-2377-12-16.","journal-title":"BMC Neurol"},{"key":"681_CR37","volume-title":"Lin E","author":"WP Wodchis","year":"2011","unstructured":"Wodchis WP, Camacho X, Dhalla I, Guttman A: Lin E. 2011, Anderson G: Targeting Health System Improvement to High Cost Patients. Canadian Association of Health Services and Policy Research. Halifax NS"},{"issue":"7","key":"681_CR38","doi-asserted-by":"publisher","first-page":"710","DOI":"10.2105\/AJPH.74.7.710","volume":"74","author":"JD Grabow","year":"1984","unstructured":"Grabow JD, Offord KP, Rieder ME: The cost of head trauma in Olmsted County Minnesota 1970\u201374. Am J Public Health. 1984, 74 (7): 710-712. 10.2105\/AJPH.74.7.710.","journal-title":"Am J Public Health"},{"issue":"2","key":"681_CR39","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/00001199-199106000-00010","volume":"6","author":"W Max","year":"1991","unstructured":"Max W, MacKenzie EJ, Rice DP: Head injuries: Costs and consequences. J Head Trauma Rehabil. 1991, 6 (2): 76-91. 10.1097\/00001199-199106000-00010.","journal-title":"J Head Trauma Rehabil"},{"issue":"3","key":"681_CR40","first-page":"191","volume":"31","author":"WG Snow","year":"1988","unstructured":"Snow WG, Macartney-Filgate MS, Schwartz ML, Klonoff PS, Ridgley BA: Demographic and medical characteristics of adult head injuries in a Canadian setting. Can J Surg. 1988, 31 (3): 191-194.","journal-title":"Can J Surg"},{"issue":"1","key":"681_CR41","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/1471-2377-11-46","volume":"11","author":"J Mar","year":"2011","unstructured":"Mar J, Arrospide A, Marie J, Larranaga I, Elosegui E, Oliva-Moreno J: The impact of acquired brain damage in terms of epidemiology economics and loss of quality of life. BMC Neurol. 2011, 11 (1): 46-10.1186\/1471-2377-11-46.","journal-title":"BMC Neurol"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-12-76.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2377-12-76\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-12-76","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-12-76.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T20:44:47Z","timestamp":1630529087000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/1471-2377-12-76"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,8,17]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["681"],"URL":"https:\/\/doi.org\/10.1186\/1471-2377-12-76","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,8,17]]},"assertion":[{"value":"29 August 2011","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 July 2012","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2012","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"76"}}