Institutional variation in traumatic brain injury acute rehabilitation practice
Model System:
TBIReference Type:
JournalAccession No.:
J72084Journal:
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
, 96, 8, Supplement 3, S197-S208Publication Website:
Abstract:
Study investigated institutional variation in traumatic brain injury (TBI) inpatient rehabilitation program characteristics and evaluated the extent to which patient factors and center effects explain how TBI inpatient rehabilitation services are delivered. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. A wide variation was observed between the 10 TBI programs, including census size, referral flow, payer mix, number of dedicated beds, clinician experience, and patient characteristics. At the centers with the longest weekday therapy sessions, the average session durations were 41.5 to 52.2 minutes. At centers with the shortest weekday sessions, the average session durations were approximately 30 minutes. The centers with the highest mean total weekday hours of occupational, physical, and speech therapies delivered twice as much therapy as the lowest center. Ordinary least-squares regression modeling found that center effects explained substantially more variance than patient factors for duration of therapy sessions, number of activities administered per session, use of group therapy, and amount of psychological services provided. Findings provide preliminary evidence that there is significant institutional variation in rehabilitation practice and that center effects play a stronger role than patient factors in determining how TBI inpatient rehabilitation is delivered.
Author(s):
Seel, Ronald T., Barrett, Ryan S., Beaulieu, Cynthia L., Ryser, David K., Hammond, Flora M., Cullen, Nora, Garmoe, William, Sommerfeld, Teri, Corrigan, John D., Horn, Susan D.