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

Brain Inj. 2013;27(2):179-88

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

Objective: To examine variations in processes of paediatric inpatient
rehabilitation care related to school re-entry and management of cognitive and
communication impairments after traumatic brain injury. Design: Retrospective
cohort study. Methods: Adherence to care processes recommended for children (aged
0-17) with moderate-to-severe traumatic brain injury and admitted for inpatient
rehabilitation was assessed. Quality-of-care indicators for processes supporting
school re-entry and cognitive and communication rehabilitation were applied to
measure variations in care delivered to 174 children across nine facilities using
medical record review. Main outcomes and results: Adherence rates (the number of
times recommended care was delivered or attempted divided by the number of times
care was indicated) were calculated, revealing substantial variations in care
within and between facilities. Overall, children received 51.3% (95%
CI = 31.9-70.7) and 72.3% (95% CI = 61.1-83.5), of the care recommended for
school re-entry and cognitive and communication rehabilitation, respectively.
Conclusion: Substantial variations exist in the delivery of paediatric inpatient
rehabilitation care processes for managing school re-entry and cognitive and
communication impairments after traumatic brain injury. Measures of association
of these care processes with patient outcomes are necessary. Reduction in this
variation is essential to improving quality of care.

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