title: Rehabilitation following pediatric traumatic brain injury: variability in adherence to psychosocial quality-of-care indicators.
abstract: OBJECTIVE
  To examine variations in processes of pediatric inpatient rehabilitation care related to family-centered care, management of neurobehavioral and psychosocial needs, and community reintegration after traumatic brain injury.
  
  
  METHODS
  Nine acute rehabilitation facilities from geographically diverse areas of the United States.
  
  
  METHODS
  A total of 174 children with traumatic brain injury.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Adherence to care indicators (the number of times recommended care was delivered or attempted divided by the number of times care was indicated).
  
  
  RESULTS
  Across facilities, adherence rates (adjusted for difficulty of delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9, 58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes, and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community integration processes. Within facilities, standard deviations for adherence rates were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and psychosocial domain; and 21.6-40.5, community reintegration domain).
  
  
  CONCLUSIONS
  The current state of acute rehabilitation care for children with traumatic brain injury is variable across different quality-of-care indicators addressing neurobehavioral and psychosocial needs and facilitating community reintegration of the patient and the family. Individual rehabilitation facilities demonstrate inconsistent adherence to different indicators and inconsistent performance across different care domains.
authors.affiliation: Harborview Injury Prevention & Research Center (Ms Ennis, Drs Jaffe and Rivara, and Mr Konodi), Department of Rehabilitation Medicine (Ms Ennis and Dr Jaffe), and Department of Pediatrics (Drs Mangione-Smith and Rivara), University of Washington, Seattle; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington (Dr Mangione-Smith); and Department of Health Policy and Management and Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr MacKenzie).
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Ennis
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Jaffe
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: Mark A
authors.initials: MA
authors.lastname: Konodi
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D062309:Community Integration; D003376:Counseling; D005190:Family; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006266:Health Education; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000592:standards*; D012189:Retrospective Studies; D012944:Social Support; D014481:United States