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Variation in adherence to new quality of care indicators for the acute rehabilitation of children with traumatic brain injury


Rivara FP, Ennis SK, Mangione-Smith R, Mackenzie EJ, Jaffe KM



Publication Info:

Archives of Physical Medicine and Rehabilitation, epub ahead of print:


OBJECTIVE: To determine variations in care provided by nine inpatient rehabilitation units for children with TBI using newly developed quality indicators.
DESIGN: Retrospective cohort study
SETTING: Study conducted in 9 inpatient rehabilitation units.
PARTICIPANTS: 174 children 0-17 years admitted for the inpatient rehabilitation of moderate to severe TBI.
INTERVENTIONS: Not applicable
MAIN OUTCOME MEASURES: Adherence to 119 newly developed quality of care indicators in seven different domains: general care, family-centered care, cognitive-communication, motor, neuropsychological, school and community integration.
RESULTS: There was substantial variation both within and between institutions in the percent of patients receiving recommended care in the seven domains. The lowest scores were found for the school domain. Only five institutions scored above 50% for all quality indicators and only one institution scored above 70% overall. Greater adherence to quality indicators was found for facilities with a higher proportion of therapists with pediatric training and for facilities that only admitted children. Patient volume was not associated with adherence to quality indicators.
CONCLUSIONS: The results indicate a tremendous variability and opportunity for improvement in the care children with TBI.

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