Variations in the quality of inpatient rehabilitation care to facilitate school re-entry and cognitive and communication function for children with TBI

Ennis, Stephanie K.; Rivara, Frederick P.; Mangione-Smith, Rita; Konodi, Mark A.; MacKenzie, Ellen J.; Jaffe, Kenneth M.

doi:10.3109/02699052.2012.729291

Cited by 14 publications

(11 citation statements)

References 29 publications

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“…In this study, quality indicators such as having pediatric trained providers, adequate specialized pediatric equipment and classrooms were more likely to be present in pediatric rehabilitation facilities. 11,12 Our finding supports the results of the quality indicator study. Further research is needed in order to examine if these child-specific services contribute to the higher discharge scores among children who received care at pediatric rehabilitation facilities.…”

Section: Discussionsupporting

confidence: 87%

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

Jimenez

Osorio

Ramos

et al. 2015

Archives of Physical Medicine and Rehabilitation

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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.

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Section: Discussionsupporting

confidence: 87%

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

Jimenez

Osorio

Ramos

et al. 2015

Archives of Physical Medicine and Rehabilitation

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“…75 The majority of research has described the transition process from hospital to school for hospitalized children. It has been shown that the return to school process is critical to children’s outcome and that successful return to school requires integration between entities, specifically the hospital and the school.…”

Section: Practices Of Carementioning

confidence: 99%

“…Transition from healthcare to school services is also characterized by substantial variability. 75 In the first year after the injury, a substantial portion of children with moderate or severe TBI have unmet (~20%) or unrecognized (~10%) healthcare needs, with cognitive services being the most frequent among these. 11 Reasons for unmet needs include lack of physician recommendation or referral, services not provided in school settings, failure of parent follow-up, and cost.…”

Section: Problems With Current Systems Of Carementioning

confidence: 99%

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

Haarbauer‐Krupa

Ciccia²,

Dodd

et al. 2017

Journal of Head Trauma Rehabilitation

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Objective To provide a review of evidence and consensus-based description of healthcare and educational service delivery and related recommendations for children with traumatic brain injury. Methods Literature review and group discussion of best practices in management of children with traumatic brain injury (TBI) was performed to facilitate consensus-based recommendations from the American Congress on Rehabilitation Medicine’s Pediatric and Adolescent Task Force on Brain Injury. This group represented pediatric researchers in public health, medicine, psychology, rehabilitation, and education. Results Care for children with TBI in healthcare and educational systems is not well coordinated or integrated, resulting in increased risk for poor outcomes. Potential solutions include identifying at-risk children following TBI, evaluating their need for rehabilitation and transitional services, and improving utilization of educational services that support children across the lifespan. Conclusion Children with TBI are at risk for long-term consequences requiring management as well as monitoring following the injury. Current systems of care have challenges and inconsistencies leading to gaps in service delivery. Further efforts to improve knowledge of the long-term TBI effects in children, child and family needs, and identify best practices in pathways of care are essential for optimal care of children following TBI.

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“…Previous studies demonstrate that even when such services are provided, parents still have difficulties navigating the complicated system of rehabilitation therapies available through clinical and school settings. 23, 24 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Variations in the quality of inpatient rehabilitation care to facilitate school re-entry and cognitive and communication function for children with TBI

Cited by 14 publications

References 29 publications

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

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

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

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

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