Article

OBJECTIVE: To describe institutional variation in traumatic brain injury (TBI)
inpatient rehabilitation program characteristics and evaluate to what extent
patient factors and center effects explain how TBI inpatient rehabilitation
services are delivered. DESIGN: Secondary analysis of a prospective, multicenter,
cohort database. SETTING: TBI inpatient rehabilitation programs. PARTICIPANTS:
Patients with complicated mild, moderate, or severe TBI (N=2130). INTERVENTIONS:
Not applicable. MAIN OUTCOME MEASURES: Mean minutes; number of treatment
activities; use of groups in occupational therapy, physical therapy, speech
therapy, therapeutic recreation, and psychology inpatient rehabilitation
sessions; and weekly hours of treatment. RESULTS: 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. CONCLUSIONS:
This study provides
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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS