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Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain
Anthony C Juliano1,2,3, Anthony H Lequerica3,4, Cherylynn Marino1,2
1Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.
Insights
Children with acquired brain injury (ABI) receiving inpatient rehabilitation fare worse with longer stays and public insurance. Longer length of stay (LOS) combined with public insurance significantly impacts functional outcomes in pediatric ABI patients.
Area of Science:
- Pediatric rehabilitation medicine
- Neuroscience
- Health services research
Background:
- Acquired brain injury (ABI) in children presents unique challenges for functional recovery.
- Inpatient rehabilitation is crucial for optimizing outcomes in pediatric ABI survivors.
- Factors influencing functional status post-rehabilitation require further investigation.
Purpose of the Study:
- To determine the impact of race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source on functional status in children with ABI.
- To analyze how these factors interact to affect functional outcomes following inpatient rehabilitation.
Main Methods:
- Retrospective cohort study of 485 pediatric patients with ABI.
- Utilized Functional Independence Measure for Children (WeeFIM) scores, transformed into age-corrected Developmental Functional Quotients (DFQ).
- Controlled for demographic and clinical variables including admission DFQ, time to rehabilitation, age, and injury aetiology.
Main Results:
- Lower discharge DFQ scores were observed for children with public insurance and longer LOS.
- A significant interaction between payer source and LOS was found (p < .001).
- Children with public insurance showed poorer outcomes primarily when LOS exceeded 28 days (p = .001).
Conclusions:
- Public insurance and extended length of stay (over 4 weeks) are associated with poorer functional outcomes in pediatric ABI patients post-rehabilitation.
- Payer source may act as a proxy for unmeasured sociodemographic factors influencing outcomes.
- These findings highlight potential disparities in care impacting functional recovery.
Objective:
To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI).
Design:
Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI.
Methods:
Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology.
Results:
Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p = .001).
Conclusion:
Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors.
