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Measuring unmet needs and services among persons with traumatic brain injury
Allen W Heinemann1, Kara Sokol, Lauree Garvin
1Department of Physical Medicine and Rehabilitation and Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, IL, USA. a-heinemann@northwestern.edu
Objectives:
(1) To develop a comprehensive list of needs and services appropriate for persons with traumatic brain injury (TBI); (2) to determine whether these needs and services formed unidimensional hierarchies from least common to most common; (3) to describe the relationship between unmet needs and services received; and (4) to estimate the extent to which a variety of demographic, injury, and service characteristics predict unmet needs.
Design:
Statewide mailed survey.
Setting:
Illinois communities.
Participants:
A total of 895 persons who had had a TBI recruited from Brain Injury Association members and rehabilitation service recipients. The median time post-TBI was 7 years; the median age was 37 years.
Interventions:
Not applicable.
Main Outcome Measures:
A 27-item instrument assessing service needs and utilization of services, and equal-interval measures of needs and services derived with Rasch analysis.
Results:
The most prevalent unmet needs were improving memory or problem-solving skills (51.9%), increasing income (50.5%), and improving job skills (46.3%). The instrument defined unidimensional and reliable constructs of needs and services. Persons with greater unmet needs tended to receive fewer services; to report lower life satisfaction and worse medical health and psychologic well-being since injury; to be younger, single, black, dependent in 1 or more daily activities; and to have more recent injuries.
Conclusions:
The results show the common pattern of unmet needs and services and emphasize the importance of comprehensive, statewide assessment of services and needs in developing policies.
