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Variations in Utilization of Inpatient Rehabilitation Services among Pediatric Trauma Patients
Huong T Nguyen1, Christopher Newton2, Elizabeth A Pirrotta3
1Divisions of Pediatric Surgery and Trauma Services, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA; Department of Emergency Medicine, School of Medicine, Stanford University, Stanford, CA.
Insights
Children with traumatic injuries from minority racial/ethnic groups and those with private insurance were more likely to receive pediatric inpatient rehabilitation services. Understanding these nonclinical variations is crucial for equitable resource allocation.
Area of Science:
- Pediatric Traumatology
- Rehabilitation Medicine
- Health Services Research
Background:
- Pediatric inpatient rehabilitation services are essential for children with severe traumatic injuries.
- Access to these services may be influenced by factors beyond clinical need.
- Understanding disparities in access is critical for equitable healthcare delivery.
Purpose of the Study:
- To investigate clinical and nonclinical factors associated with the utilization of pediatric inpatient rehabilitation services.
- To test the hypothesis that nonclinical variations do not influence service use.
Main Methods:
- Retrospective analysis of 1139 pediatric trauma patients (2004-2014).
- Full matching technique comparing rehabilitation admissions to home discharges.
- Multivariate logistic regression controlling for clinical and nonclinical variables.
Main Results:
- 8.6% of patients were admitted to inpatient rehabilitation.
- Minority patients (Black, other) had higher odds of rehabilitation admission compared to white patients.
- Patients with private insurance had significantly higher odds of rehabilitation admission than those with public insurance.
Conclusions:
- Nonclinical factors, including race/ethnicity and insurance status, are associated with the use of pediatric inpatient rehabilitation.
- Disparities in access exist and require further investigation.
- Ensuring equitable access to scarce rehabilitation resources is paramount.
Objective:
To assess clinical and nonclinical characteristics associated with the use of pediatric inpatient rehabilitation services among children with traumatic injuries. We hypothesized there would be no nonclinical variations in the use of pediatric inpatient rehabilitation services.
Study Design:
Retrospective analysis of 1139 patients who were injured seriously (0-18 years of age) from our institutional trauma registry (2004-2014). Patients' nonclinical and clinical characteristics were analyzed. We used a full matching technique to compare characteristics between those admitted to rehabilitation (cases) to those discharged home (controls). We matched patients by age category, sex, maximum Abbreviated Injury Scale, and body region of maximum Abbreviated Injury Scale. We used survey-based multivariate logistic regression to identify characteristics associated with inpatient rehabilitation services, controlling for multiple injuries, distance from home to rehabilitation center, year of service, hospital length of stay, and clinically relevant interactions.
Results:
Ninety-eight patients (8.6%) were admitted to inpatient rehabilitation and 968 (85.0%) were discharged home. Black and other minority patients had increased odds of receiving inpatient rehabilitation compared with white patients (OR, 7.6 [P< .001] and OR, 1.6 [P= .03], respectively). Patients with private compared with public insurance had increased odds of receiving inpatient rehabilitation (OR, 2.4; P< .001).
Conclusions:
Pediatric inpatient rehabilitation beds are a scarce resource that should be available to those with the greatest clinical need. The mechanism creating differences in the use of inpatient rehabilitation based on nonclinical characteristics such as race/ethnicity or insurance status must be understood to prevent disparities in access to inpatient rehabilitation services.
