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

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.