Variation in adherence to new quality-of-care indicators for the acute rehabilitation of children with traumatic brain injury

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

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective: To determine variations in care provided by 9 inpatient rehabilitation units for children with traumatic brain injury (TBI) using newly developed quality indicators. Design: Retrospective cohort study. Setting: Nine inpatient rehabilitation units. Participants: Children (N=174; age range, 0-17y) admitted for the inpatient rehabilitation of moderate to severe TBI. Interventions: Not applicable. Main Outcome Measures: Adherence 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. Results: There 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. Conclusions: The results indicate a tremendous variability and opportunity for improvement in the care of children with TBI.

Original languageEnglish (US)
Pages (from-to)1371-1376
Number of pages6
JournalArchives of physical medicine and rehabilitation
Issue number8
StatePublished - Aug 2012


  • Adolescent
  • Child
  • Quality of health care
  • Rehabilitation
  • Traumatic brain injuries

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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