Quality of Care Indicators for the Structure and Organization of Inpatient Rehabilitation Care of Children With Traumatic Brain Injury

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 3; pp. 386 - 393.e1
• Main Authors: Zumsteg, Jennifer M., MD, Ennis, Stephanie K., MS, CCC-SLP, Jaffe, Kenneth M., MD, Mangione-Smith, Rita, MD, MPH, MacKenzie, Ellen J., PhD, Rivara, Frederick P., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Biological and medical sciences; Brain injuries; Brain Injuries - psychology; Brain Injuries - rehabilitation; Child; Communication; Diseases of the osteoarticular system; Family; Health Personnel; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Inpatients; Medical sciences; Miscellaneous; Outcome and process assessment (health care); Outcome and Process Assessment (Health Care) - organization & administration; Outcome and Process Assessment (Health Care) - standards; Pediatrics; Pediatrics - organization & administration; Pediatrics - standards; Physical Medicine and Rehabilitation; Quality Indicators, Health Care; Quality of health care; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Rehabilitation Centers - organization & administration; Rehabilitation Centers - standards; Traumas. Diseases due to physical agents; United States; United States; Outcome and process assessment (health care); RR; Pediatrics; CI; traumatic brain injury; CARF; Brain injuries; relative risk; RAND/UCLA Appropriateness Method; Commission on Accreditation of Rehabilitation Facilities; CRRN; Quality of health care; confidence interval; TBI; Rehabilitation; certified rehabilitation registered nurse; RAM; Human; Nervous system diseases; Prognosis; Indicator; Care; Cerebral disorder; Reeducation; Orthopedics; Quality; Central nervous system disease; Head trauma; Child
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2011.08.018

Abstract Zumsteg JM, Ennis SK, Jaffe KM, Mangione-Smith R, MacKenzie EJ, Rivara FP, and the National Expert Panel for the Development of Pediatric Rehabilitation Quality of Care Indicators. Quality of care indicators for the structure and organization of inpatient rehabilitation care of children with traumatic brain injury. Objectives To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care. Design Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities. Setting Inpatient rehabilitation units in the United States. Participants A sample of rehabilitation programs identified using data from the National Association of Children's Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all age units. Interventions Not applicable. Main Outcome Measures Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI. Results Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least 1 child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and more than 75% of therapists with pediatric training. Conclusions There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI.