Abstract
Zumsteg JM, Ennis SK, Jaffe KM, Mangione-Smith R, MacKenzie EJ, Rivara FP, and the
National Expert Panel for the Development of Pediatric Rehabilitation Quality of Care
Indicators. Quality of care indicators for the structure and organization of inpatient
rehabilitation care of children with traumatic brain injury.
Objectives
To develop evidence-based and expert-driven quality indicators for measuring variations
in the structure and organization of acute inpatient rehabilitation for children after
traumatic brain injury (TBI) and to survey centers across the United States to determine
the degree of variation in care.
Design
Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence
to these indicators was determined from a survey of rehabilitation facilities.
Setting
Inpatient rehabilitation units in the United States.
Participants
A sample of rehabilitation programs identified using data from the National Association
of Children's Hospitals and Related Institutions, Uniform Data System for Medical
Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded
74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric
and 28 all age units.
Interventions
Not applicable.
Main Outcome Measures
Variations in structure and organization of care among institutions providing acute
inpatient rehabilitation for children with TBI.
Results
Twelve indicators were developed. Pediatric inpatient rehabilitation units and units
with higher volumes of children with TBI were more likely to have: a census of at
least 1 child admitted with a TBI for at least 90% of the time; adequate specialized
equipment; a classroom; a pediatric subspecialty trained medical director; and more
than 75% of therapists with pediatric training.
Conclusions
There were clinically and statistically significant variations in the structure and
organization of acute pediatric rehabilitation based on the pediatric focus of the
unit and volume of children with TBI.
Key Words
List of Abbreviations:
CARF (Commission on Accreditation of Rehabilitation Facilities), CI (confidence interval), CRRN (certified rehabilitation registered nurse), RAM (RAND/UCLA Appropriateness Method), RR (relative risk), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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References
- Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta2010
- Pediatric trauma rehabilitation: a value-added safety net.J Trauma. 2008; 64: 819-823
- Directions in brain injury research: from concept to clinical implementation.Neuropsychol Rehabil. 2009; 19: 807-823
- The traumatic brain injury model systems: history and contributions to clinical service and research.J Head Trauma Rehabil. 2010; 25: 81-91
- Explorations in quality assessment and monitoring: the definition of quality and approaches to its assessment.Health Administration Pr, Ann Arbor1980
- State-of-the-science on post-acute rehabilitation: measurement and methodologies for assessing quality and establishing policy for postacute care.Arch Phys Med Rehabil. 2007; 88: 1482-1487
- Rehabilitation for traumatic brain injury in children and adolescents.Evid Rep Technol Assess (Summ). 1999; : 1-5
- Postacute rehabilitation research and policy recommendations.Arch Phys Med Rehabil. 2007; 88: 1535-1541
- The impact of trauma-center care on functional outcomes following major lower-limb trauma.J Bone Joint Surg Am. 2008; 90: 101-109
- A national evaluation of the effect of trauma-center care on mortality.N Engl J Med. 2006; 354: 366-378
- Organizational interventions to improve health outcomes of older persons.Med Care. 2002; 40: 416-428
- Medical rehabilitation standards manual.CARF Document Production, Tucson2009
- Traumatic brain injury: diagnosis, acute management and rehabilitation.Accident Compensation Corporation, Wellington2006
- Evidence-based review of moderate to severe acquired brain injury.(5th web ed.) (Accessed: November 30, 2009)
- Turner-Stokes L. Rehabilitation following acquired brain injury: national clinical guidelines. British Society of Rehabilitation Medicine, London2003
Emergency medical services and trauma systems. Chapter 246-976 WAC; March 22, 2011.
- Levels of Evidence.(Accessed March 2009)
- The RAND/UCLA Appropriateness Method.in: McCormick K.A. Moore S.R. Siegel R.A. Methodological perspectives. U.S. Department of Health and Human Services, Rockville1994
- The RAND/UCLA Appropriateness Method user's manual.RAND, Santa Monica2006
- A method for the detailed assessment of the appropriateness of medical technologies.Int J Technol Assess Health Care. 1986; 2: 53-63
- Assessing the predictive ability of the RAND/UCLA appropriateness method criteria for performing carotid endarterectomy.Int J Technol Assess Health Care. 1998; 14: 707-727
- Measuring the clinical consistency of panelists' appropriateness ratings: the case of coronary artery bypass surgery.Health Policy. 1997; 42: 135-143
- Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization.N Engl J Med. 2001; 344: 645-654
- Methodological considerations in hospital patient opinion surveys.Int J Nurs Stud. 1981; 18: 7-32
- Response rate in patient satisfaction research: an analysis of 210 published studies.Int J Qual Health Care. 1998; 10: 311-317
- The quality of care: how can it be assessed?.JAMA. 1988; 260: 1743-1748
- Structure, process, and outcomes in stroke rehabilitation.Med Care. 2002; 40: 1036-1047
- Disparities in the delivery of pediatric trauma care.J Trauma. 2009; 67: S114-S119
- Improved functional outcome for severely injured children treated at pediatric trauma centers.J Trauma. 2001; 51 (discussion 32-4): 824-832
- Pediatric specialized transport teams are associated with improved outcomes.Pediatrics. 2009; 124: 40-48
- Source of admission and outcomes for critically injured children in the mountain states.Arch Pediatr Adolesc Med. 2010; 164: 277-282
- Pediatric rehabilitation nursing: education and certification.J Pediatr Rehabil Med. 2008; 1: 51-56
- The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.Med Care. 2007; 45: 1195-1204
- Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.JAMA. 2002; 288: 1987-1993
- Implications of the California nurse staffing mandate for other states.Health Serv Res. 2010; 45: 904-921
- Patients' perception of hospital care in the United States.N Engl J Med. 2008; 359: 1921-1931
- Differences in rehabilitation services and outcomes among stroke patients cared for in veterans hospitals.Health Serv Res. 2001; 35: 1293-1318
- Relationship between trauma center volume and outcomes.JAMA. 2001; 285: 1164-1171
- Hospital volume and surgical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137
- Is volume related to outcome in health care?.Ann Intern Med. 2002; 137: 511-520
Article info
Publication history
Published online: January 27, 2012
Footnotes
Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (grant no. R21 HD059049-01A1).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Invited Commentary on Quality of Care Indicators for the Rehabilitation of Children With Traumatic Brain Injury, and Quality of Care Indicators for the Structure and Organization of Inpatient Rehabilitation Care of Children With Traumatic Brain InjuryArchives of Physical Medicine and RehabilitationVol. 93Issue 3
- PreviewWhyte J. Invited commentary on quality of care indicators for the rehabilitation of children with traumatic brain injury, and quality of care indicators for the structure and organization of inpatient rehabilitation care of children with traumatic brain injury. Measures of structure and process in health care have been shown to be associated with care outcomes in prior research. Two articles in this issue propose measures of structure and process that may be relevant to pediatric traumatic brain injury rehabilitation.
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- Can Quality of Care Indicators Measure Quality of Care?Archives of Physical Medicine and RehabilitationVol. 93Issue 11
- PreviewWe found the recent articles1,2 and commentary3 on quality of care measures in pediatric traumatic brain injury (TBI) to be informative, thought-provoking, and yet somewhat disheartening. The work of the National Expert Panel for the Development of Pediatric Quality of Care Indicators strives to advance quality in pediatric TBI with designation of quality indicators and the demonstration of meaningful variations of adherence in a subset of indicators across rehabilitation units. The work offers a foundation to study quality in this population, and from such a platform, design and implement worthwhile quality improvement (QI) initiatives.
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