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Utilization of ICU Rehabilitation Services in Pediatric Patients With a Prolonged ICU Stay
Kristina A Betters1, Truc M Le1, Wu Gong2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
Insights
Rehabilitation services vary widely for critically ill children. High utilization in the ICU may reduce need for inpatient rehab and pressure injuries, but more research is needed.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation therapy
- Healthcare quality improvement
Background:
- Critically ill children with prolonged intensive care unit (ICU) stays often require rehabilitation services.
- Practice patterns for providing rehabilitation to these vulnerable patients are not well-described.
- Understanding these patterns is crucial for optimizing patient outcomes.
Purpose of the Study:
- To describe current rehabilitation practice patterns for critically ill children with prolonged ICU stays.
- To investigate the association between hospital-level rehabilitation service utilization and patient outcomes.
Main Methods:
- Retrospective cohort study utilizing administrative data from 51 US pediatric hospitals.
- Identified critically ill children with ICU stays of at least 7 days between July 2016 and June 2017.
- Categorized hospitals into quartiles based on physical and occupational therapy utilization rates.
Main Results:
- Significant variability in rehabilitation service utilization was observed across hospitals.
- 35% of eligible encounters did not receive physical or occupational therapy charges.
- Higher rehabilitation utilization was associated with lower rates of discharge to inpatient rehabilitation facilities and new pressure injuries in univariate analyses.
Conclusions:
- There is substantial institutional variation in the provision of rehabilitation services for critically ill children in the US.
- Further investigation is warranted to confirm the benefits of high-intensity rehabilitation during prolonged pediatric critical illness.
Objectives:
To describe rehabilitation practice patterns among critically ill children with prolonged ICU stays and explore the association between institution-level utilization of rehabilitative services and patient outcomes.
Design:
Retrospective cohort study using an administrative database of inpatient clinical and resource utilization data from participating pediatric hospitals in the United States. Center-level utilization of physical therapy and occupational therapy among critically ill patients was used to divide hospitals by quartile into high utilization centers or standard utilization centers.
Setting:
Fifty-one pediatric hospitals in the United States.
Patients:
Critically ill pediatric patients with prolonged critical illness (defined as an ICU length of stay of at least 7 d) discharged from July 2016 to June 2017.
Interventions:
Not applicable.
Measurements And Main Results:
Seventeen thousand four hundred seventy encounters met criteria for study inclusion. Of those, 6,040 (35%) were not charged for either physical therapy or occupational therapy services. There was wide variability in center-level utilization of rehabilitative services while in the ICU, ranging from 81% utilization of physical therapy or occupational therapy services among high utilization centers to 46% utilization among centers within the lowest quartile. In univariate analyses, children cared for at an high utilization center were less likely to require discharge to an inpatient rehabilitation facility (1.7% vs 3.5%; p < 0.001) and less likely to incur a new pressure injury (2.2% vs 3.1%; p = 0.001). In multivariable analyses, the direction and magnitude of effects remained similar, although the effect was no longer statistically significant (discharge to inpatient rehabilitation facility: odds ratio, 0.64; 95% CI, 0.18-2.26; pressure injury: odds ratio, 0.77; 95% CI, 0.48-1.24).
Conclusions:
Institutional use of rehabilitative services for children with prolonged critical illness varies greatly in the United States. Further research is needed into the potential benefits for patients cared for at centers with high usage of rehabilitation services in the ICU during prolonged critical illness.
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