Research Reports - Institutional variation in traumatic brain injury acute rehabilitation practice

Arch Phys Med Rehabil. 2015 Aug;96(8 Suppl):S197-208. doi:

Seel RT(1), Barrett RS(2), Beaulieu CL(3), Ryser DK(4), Hammond FM(5), Cullen
N(6), Garmoe W(7), Sommerfeld T(8), Corrigan JD(9), Horn SD(2).

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.
DESIGN: Secondary analysis of a prospective, multicenter, cohort database.
SETTING: TBI inpatient rehabilitation programs.
PARTICIPANTS: Patients with complicated mild, moderate, or severe TBI (N=2130).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: 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
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. 

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