Association between facility type during pediatric inpatient rehabilitation and functional outcomes

Publication date: Available online 26 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Molly M. Fuentes, Susan Apkon, Nathalia Jimenez, Frederick P. Rivara
ObjectiveTo compare functional outcomes between children receiving inpatient rehabilitation at children's hospitals versus other facilities.DesignRetrospective cohort study using the Uniform Data System for Medical Rehabilitation Functional Independence Measure for Children (WeeFIM^®) national dataset, 2004-2014.SettingU.S. inpatient rehabilitation facilities.ParticipantsChildren (n=28,793) aged 6 months to 18 years who received initial inpatient rehabilitation.InterventionsNot applicable.Main Outcome MeasuresTotal, cognitive, and motor developmental functional quotients (DFQ, which is the WeeFIM score divided by age-adjusted norms x 100) at discharge from inpatient rehabilitation and WeeFIM efficiency (change in WeeFIM score divided by length of stay), adjusting for age, gender, race, insurance, region, admission function, impairment type, discharge year, and length of stay.Results12,732 children received rehabilitation at 25 children's hospitals and 16,061 at 36 other facilities (general hospitals or freestanding rehabilitation hospitals). Adjusting for clustering by facility, patients at children's hospitals had lower cognitive DFQ at admission (difference between children's hospitals and other facility types: -3.8 (95% confidence interval (CI) -7.7, -0.1), shorter lengths of stay (median 16 days versus 22 days, p<.001), and higher WeeFIM efficiency (difference 0.63 (95% CI 0.25, 1.00)) than children at other facility types. Rehabilitation in a children's hospital was independently associated with higher discharge cognitive DFQ (regression coefficient 2.3, 95% CI 0.3 to 4.2) and more efficient rehabilitation admissions (regression coefficient 0.3, 95% CI 0.1 to 0.6).ConclusionsChildren who receive inpatient rehabilitation at children's hospitals have more efficient inpatient rehabilitation admissions, a shorter median length of stay, and a small improvement in cognitive function compared to children at other types of facilities.



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