title: Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury.
abstract: To describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services.
  
  
  
  Retrospective cohort of children <21 years, hospitalized for a TBI between 2007 and 2012, from a national Medicaid claims database. Outcome measures were receipt of outpatient rehabilitation (physical, occupational, or speech therapies or physician visits to a rehabilitation provider) 1 and 3 years after discharge. Multivariable regression analyses determined the association of demographic variables, injury severity, and receipt of inpatient services with receipt of outpatient rehabilitation at 1 and 3 years. The mean number of services was compared between racial/ethnic groups.
  
  
  
  Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy.
  
  
  
  Hospitalized children who received inpatient assessment of rehabilitation needs were more likely to continue outpatient rehabilitation care. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy. Interventions to increase inpatient rehabilitation during acute care might increase outpatient rehabilitation and improve outcomes for all children.
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, nathalia.jimenez@seattlechildrens.org.
authors.forename: Nathalia
authors.initials: N
authors.lastname: Jimenez
authors.affiliation: Harborview Injury Prevention and Research Center.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Symons
authors.affiliation: Harborview Injury Prevention and Research Center.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Harborview Injury Prevention and Research Center, Pediatrics, Epidemiology.
authors.forename: Beth H
authors.initials: BH
authors.lastname: Ebel
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Pediatrics.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Center for Clinical and Epidemiological Research.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
authors.affiliation: Neurologic Surgery, Biostatistics, and.
authors.forename: Nancy
authors.initials: N
authors.lastname: Temkin
authors.affiliation: Harborview Injury Prevention and Research Center, Pediatrics, Neurologic Surgery, Rehabilitation Medicine, University of Washington, Seattle, Washington.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Jaffe
authors.affiliation: Harborview Injury Prevention and Research Center, Pediatrics, Epidemiology.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000070642:Brain Injuries, Traumatic / Q000208:ethnology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult