title: Institutional Variation in Traumatic Brain Injury Acute Rehabilitation Practice.
abstract: 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.
  
  
  METHODS
  Secondary analysis of a prospective, multicenter, cohort database.
  
  
  METHODS
  TBI inpatient rehabilitation programs.
  
  
  METHODS
  Patients with complicated mild, moderate, or severe TBI (N=2130).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA. Electronic address: ron_seel@shepherd.org.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Seel
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Brooks Rehabilitation Hospital, Jacksonville, FL.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Beaulieu
authors.affiliation: Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Ryser
authors.affiliation: Carolinas Rehabilitation, Charlotte, NC; Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
authors.affiliation: Medstar National Rehabilitation Hospital, Washington, DC.
authors.forename: William
authors.initials: W
authors.lastname: Garmoe
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Teri
authors.initials: T
authors.lastname: Sommerfeld
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation*; D002170:Canada; D005260:Female; D006801:Humans; D007325:Institutional Practice / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D011159:Population Surveillance; D011446:Prospective Studies; D057173:Recreation Therapy; D013070:Speech Therapy; D016896:Treatment Outcome; D014481:United States
keywords: Brain injuries; Craniocerebral trauma; Health services; Health services research; Occupational therapy; Physical therapy specialty; Psychology; Recreation therapy; Rehabilitation; Speech therapy; Therapeutics