title: Variation in adherence to new quality-of-care indicators for the acute rehabilitation of children with traumatic brain injury.
abstract: OBJECTIVE
  To determine variations in care provided by 9 inpatient rehabilitation units for children with traumatic brain injury (TBI) using newly developed quality indicators.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Nine inpatient rehabilitation units.
  
  
  METHODS
  Children (N=174; age range, 0-17y) admitted for the inpatient rehabilitation of moderate to severe TBI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 91804, USA. fpr@uw.edu
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Ennis
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Jaffe
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies