TY - JOUR
T1 - Rehabilitation following pediatric traumatic brain injury
T2 - Variability in adherence to psychosocial quality-of-care indicators
AU - Ennis, Stephanie K.
AU - Jaffe, Kenneth M.
AU - Mangione-Smith, Rita
AU - Konodi, Mark A.
AU - Mackenzie, Ellen J.
AU - Rivara, Frederick P.
PY - 2014
Y1 - 2014
N2 - Objective: To examine variations in processes of pediatric inpatient rehabilitation care related to family-centered care, management of neurobehavioral and psychosocial needs, and community reintegration after traumatic brain injury. Setting: Nine acute rehabilitation facilities from geographically diverse areas of the United States. Participants: A total of 174 children with traumatic brain injury. Design: Retrospective chart review. MAIN MEASURES: Adherence to care indicators (the number of times recommended care was delivered or attempted divided by the number of times care was indicated). Results: Across facilities, adherence rates (adjusted for difficulty of delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9, 58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes, and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community integration processes. Within facilities, standard deviations for adherence rates were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and psychosocial domain; and 21.6-40.5, community reintegration domain). Conclusion: The current state of acute rehabilitation care for children with traumatic brain injury is variable across different quality-of-care indicators addressing neurobehavioral and psychosocial needs and facilitating community reintegration of the patient and the family. Individual rehabilitation facilities demonstrate inconsistent adherence to different indicators and inconsistent performance across different care domains.
AB - Objective: To examine variations in processes of pediatric inpatient rehabilitation care related to family-centered care, management of neurobehavioral and psychosocial needs, and community reintegration after traumatic brain injury. Setting: Nine acute rehabilitation facilities from geographically diverse areas of the United States. Participants: A total of 174 children with traumatic brain injury. Design: Retrospective chart review. MAIN MEASURES: Adherence to care indicators (the number of times recommended care was delivered or attempted divided by the number of times care was indicated). Results: Across facilities, adherence rates (adjusted for difficulty of delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9, 58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes, and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community integration processes. Within facilities, standard deviations for adherence rates were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and psychosocial domain; and 21.6-40.5, community reintegration domain). Conclusion: The current state of acute rehabilitation care for children with traumatic brain injury is variable across different quality-of-care indicators addressing neurobehavioral and psychosocial needs and facilitating community reintegration of the patient and the family. Individual rehabilitation facilities demonstrate inconsistent adherence to different indicators and inconsistent performance across different care domains.
KW - pediatric
KW - quality-of-care
KW - rehabilitation
KW - traumatic brain injury
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U2 - 10.1097/HTR.0b013e3182987dd4
DO - 10.1097/HTR.0b013e3182987dd4
M3 - Article
C2 - 23835875
AN - SCOPUS:84900497039
SN - 0885-9701
VL - 29
SP - 208
EP - 216
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 3
ER -