Variation in Adherence to New Quality-of-Care Indicators for the Acute Rehabilitation of Children With Traumatic Brain Injury

Rivara FP, Ennis SK, Mangione-Smith R, MacKenzie EJ, Jaffe KM. Variation in adherence to new quality-of-care indicators for the acute rehabilitation of children with traumatic brain injury.ObjectiveTo determine variations in care provided by 9 inpatient rehabilitation units for children with traumatic brain injury (TBI) using newly developed quality indicators.DesignRetrospective cohort study.SettingNine inpatient rehabilitation units.ParticipantsChildren (N=174; age range, 0–17y) admitted for the inpatient rehabilitation of moderate to severe TBI.InterventionsNot applicable.Main Outcome MeasuresAdherence to 119 newly developed quality-of-care indicators in 7 different domains: general care, family-centered care, cognitive-communication, motor, neuropsychological, school, and community integration.ResultsThere was substantial variation both within and between institutions in the percentage of patients receiving recommended care in the 7 domains. The lowest scores were found for the school domain. Only 5 institutions scored above 50% for all quality indicators, and only 1 institution scored above 70% overall. Greater adherence to quality indicators was found for facilities with a higher proportion of therapists with pediatric training and for facilities that only admitted children. Patient volume was not associated with adherence to quality indicators.ConclusionsThe results indicate a tremendous variability and opportunity for improvement in the care of children with TBI.