Delivery of pediatric rehabilitation services has changed during the past decade — with length of stay decreasing, according to research presented at the Association for Academic Physiatrists Annual Meeting in Sacramento, Calif.
Recent studies have shown discrepancies in the structures and processes of pediatric rehab both within and among different facilities. Other studies have looked at what determines a child’s length of stay when admitted to an inpatient rehab program. Evidence from these studies suggests age, diagnosis and a child’s functional status when admitted are all factors in determining length of stay; however, no studies have addressed national trends, according to a news release.
To fill this research gap, investigators conducted a retrospective study to evaluate overall trends in pediatric inpatient rehab and how care is changing in regard to patient demographics, health and functional characteristics and the characteristics of facilities. The researchers also hoped to identify characteristics of patients and facilities that predict length of stay and effectiveness of treatment and characterize regional differences in rehab care.
Using a standardized reporting system that reviews the operation and performance of health centers, the researchers looked at WeeFIM data — which assigns points for independence based on how well a child performs daily tasks such as walking, communicating and getting dressed — from 67 pediatric inpatient rehabilitation centers in the U.S. between 2004 and 2014. These data represent 42,702 inpatient pediatric rehabilitation admissions.
The researchers looked at the length of stay for patients, their WeeFIM scores at admission, WeeFIM functional gains and WeeFIM efficiency. They also looked at 11 different variables that could affect overall trends, including length of stay, patient age, co-existing diseases and conditions, gender, race, location of the rehab facility, insurance type (public vs. private), admission WeeFIM score, facility type (freestanding or hospital-unit based), facility size and discharge year.
Findings showed length of stay varied as widely as one to 944 days during the study period, with the average length of stay being 28 days. More specifically, the average length of stay dropped from 31 days in 2004 to 24 days in 2014, researchers found.
“Our study tells us that the number of days children spent in inpatient rehabilitation decreased during the last 10 years,” researchers Tracy Knippel, MD, and Amy Houtrow, MD, PhD, MPH, said in the release.
Knippel is a third-year resident at University of Pittsburgh Medical Center and Houtrow is an associate professor of PM&R and pediatrics at the University of Pittsburgh.
“Our study doesn’t tell us why it happened, but we do know that the number of days adults spend in inpatient rehabilitation has decreased as well in the recent past,” they said in the release. “We think that children and adults are spending less time in inpatient rehabilitation in part because the process of rehabilitation care has gotten more efficient and in part due to pressures from insurance companies to get patients home as quickly as possible.”
The data showed WeeFIM scores at admission remained relatively stable during the study period; WeeFIM efficiency improved significantly over time; and WeeFIM gain decreased significantly. This decrease in WeeFIM gain indicates a trend toward more children being discharged home with more functional limitations, according to the researchers, which shifts recovery to an outpatient setting.
Results showed some children improved more than others during their time doing inpatient rehabilitation. Researchers also noted older children, children with private insurance, children who stayed only a short time in inpatient rehabilitation and children who lived in the Northeast did the best in inpatient rehab, but they said more research is needed to figure out the reasons.
Knippel and Houtrow also evaluated trends at the facility level and found the total number of freestanding facilities remained stable during the study period but decreased as a percentage of total facilities providing pediatric rehab services (dropping from 26% in 2004 to 20% in 2014) showing a trend toward hospital-based rehab. Findings showed the largest number of inpatient rehabilitation facilities from 2004 to 2014 were in the Northeastern U.S.
Finally, Knippel and Houtrow evaluated specific impairment groups and the percentage change in rehabilitation admissions each experienced during the study period. Physical weakness, or debility, accounted for zero inpatient rehab admissions in 2004 and increased to 5% of admissions by 2014. In 2004, musculoskeletal conditions accounted for 15% of admissions; this decreased to 8.6% in 2014. By comparison, acquired brain injuries consistently represented about 50% of all inpatient rehabilitation admissions throughout the study period.
Overall, this retrospective study indicates inpatient pediatric rehabilitation has changed significantly in the past decade. Some of the change – like more efficient care – is positive, according to Knippel and Houtrow. But, they also found issues of concern, such as variability in care and children being discharged from inpatient rehabilitation earlier.
“As we work to provide the highest quality of care for children, we need to make sure they are getting the rehabilitation services they need to be as healthy and functional as possible so that they can do the things in life that they want to do,” Knippel and Houtrow said in the release.
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