Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury

Abstract

OBJECTIVES To describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services. METHODS Retrospective cohort of children <21 years, hospitalized for a TBI between 2007 and 2012, from a national Medicaid claims database. Outcome measures were receipt of outpatient rehabilitation (physical, occupational, or speech therapies or physician visits to a rehabilitation provider) 1 and 3 years after discharge. Multivariable regression analyses determined the association of demographic variables, injury severity, and receipt of inpatient services with receipt of outpatient rehabilitation at 1 and 3 years. The mean number of services was compared between racial/ethnic groups. RESULTS Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy. CONCLUSIONS Hospitalized children who received inpatient assessment of rehabilitation needs were more likely to continue outpatient rehabilitation care. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy. Interventions to increase inpatient rehabilitation during acute care might increase outpatient rehabilitation and improve outcomes for all children.

Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury

“…13 In brief, it contains individual-level inpatient and outpatient medical claims; each claim includes date, place, and type of medical service and associated diagnoses. It also provides demographic information on the patient at the time of service, and data on Medicaid enrollment.…”

Service Delivery in the Healthcare and Educational Systems for Children Following Traumatic Brain Injury: Gaps in Care

“…3,11,71 In a recent study of Medicaid-insured children hospitalized after TBI, only 29% received any type of outpatient services regardless of TBI severity. 72 Furthermore, a study of Medicaid service availability in the state of Washington found that less than 20% of all rehabilitation providers in the statewide database accepted Medicaid. 73 …”

“…Many parents leave the hospital with limited understanding of a need to change their child’s school program as a result of a TBI 10 and experience difficulties coordinating healthcare and school-based rehabilitation services. 72 School personnel often do not have training on identification and management of students with TBI. 76,77 …”

“…Most children with TBI are discharged to home following initial injury care at the ED 65 and only a small percentage receive outpatient services. 72 Currently, there are no systems or guidelines in place for determining service eligibility or procedures for monitoring of children’s progress after a TBI.…”

“…71,72 Although a neuropsychological evaluation can provide targeted recommendations to facilitate optimal school reintegration, research findings indicate these evaluations are rarely conducted (0.1%). 3 …”