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.