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. 2016 Jun;137(6):e20153500.
doi: 10.1542/peds.2015-3500. Epub 2016 May 6.

Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury

Nathalia Jimenez  1 , Rebecca G Symons  2 , Jin Wang  2 , Beth H Ebel  3 , Monica S Vavilala  4 , Dedra Buchwald  5 , Nancy Temkin  6 , Kenneth M Jaffe  7 , Frederick P Rivara  3
Affiliations

Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury

Nathalia Jimenez et al. Pediatrics. 2016 Jun.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Proportion of patients who received outpatient rehabilitation after TBI. Error bars represent 95% CIs.
FIGURE 2
FIGURE 2
Median number and IQR25–75 of outpatient rehabilitation visits after TBI.
See this image and copyright information in PMC

References

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