Functional Independence After Inpatient Rehabilitation for Traumatic Brain Injury Among Minority Children and Adolescents

Abstract

Objective To compare motor and cognitive functional independence scores between Hispanic, non-Hispanic Black (NHB) and non-Hispanic White (NHW) children with traumatic brain injury (TBI) after discharge from inpatient rehabilitation. Design Retrospective cohort study using the Uniform Data System for Medical Rehabilitation national dataset from years 2002–2012. Setting Inpatient rehabilitation units. Participants 10,141 children 6 months to 18 years of age who received inpatient rehabilitation for TBI. Interventions not applicable. Main outcome measures Motor and cognitive functional independence after discharge from inpatient rehabilitation; adjusting for age, gender, admission function, length of stay, insurance and region. Results Inpatient rehabilitation therapy improved functional independence for all children. Younger age, lower admission functional independence scores and Medicaid insurance were associated with lower functional independence at discharge. Hispanic and NHB children had lower discharge cognitive scores compared to NHW children; however differences were small and were partially explained by insurance status and region. Children who received rehabilitation therapy at pediatric facilities had greater cognitive improvement. Conclusion While racial/ethnic disparities are small, minority children are more likely to be younger, to have Medicaid and to be cared for at non-pediatric facilities, factors that increase their risk for lower functional outcomes.

Association Between Facility Type During Pediatric Inpatient Rehabilitation and Functional Outcomes

“…As with the previous study of children with TBI, 8 this study found racial/ethnic and insurance-based differences in receipt of rehabilitation at children’s hospital–based rehabilitation units. This study’s findings of improved efficiency of rehabilitation admissions with shorter lengths of stay at children’s hospital–based rehabilitation units suggest that children, particularly those with impairments affecting cognitive function, would be best served at rehabilitation units within a children’s hospital setting.…”

“…8 The development of evidence-based and expert-endorsed quality-of-care indicators focusing on the structure, organization, and processes of care of pediatric inpatient rehabilitation was undertaken with the ultimate goal of improving patients’ outcomes. The quality-of-care indicators focused on those that may affect functional outcomes for children with TBI 15 but will likely operate similarly for children with all diagnoses relevant to inpatient pediatric rehabilitation.…”

“…Primary payer was categorized as private/commercial insurance coverage, Medicaid/Medicare or other governmental insurance, and other (including self-pay and unreimbursed care). Regional variations in functional outcomes were shown in a previous study of children with TBI 8 ; thus, region was included as an independent variable. Region was coded in the UDSMR as 1 of the 10 Centers for Medicare & Medicaid Services regions and reclassified as Northeast, South, Midwest, and West.…”

“…A recent analysis of 4839 children with traumatic brain injury (TBI) found that children who received inpatient rehabilitation at children’s hospitals had higher cognitive functional scores at discharge than did children admitted to rehabilitation units based at general hospitals. 8 It is not known whether rehabilitation at children’s hospitals has a similar effect on functional outcome for diagnoses other than TBI.…”

Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury

“…Similar to this study, a recent study found the effect of Hispanic and Non-Hispanic Black race/ethnicity on discharge function after inpatient rehabilitation for TBI was non-significant after adjustment for other variables including insurance status [26]. …”