Harborview Injury Prevention & Research Center (Ms Ennis, Drs Jaffe and Rivara, and Mr Konodi), Department of Rehabilitation Medicine (Ms Ennis and Dr Jaffe), and Department of Pediatrics (Drs Mangione-Smith and Rivara), University of Washington, Seattle; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington (Dr Mangione-Smith); and Department of Health Policy and Management and Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr MacKenzie).
J Head Trauma Rehabil. 2014 May-Jun;29(3):208-16. doi: 10.1097/HTR.0b013e3182987dd4.
To examine variations in processes of pediatric inpatient rehabilitation care related to family-centered care, management of neurobehavioral and psychosocial needs, and community reintegration after traumatic brain injury.
Nine acute rehabilitation facilities from geographically diverse areas of the United States.
A total of 174 children with traumatic brain injury.
Retrospective chart review.
Adherence to care indicators (the number of times recommended care was delivered or attempted divided by the number of times care was indicated).
Across facilities, adherence rates (adjusted for difficulty of delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9, 58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes, and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community integration processes. Within facilities, standard deviations for adherence rates were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and psychosocial domain; and 21.6-40.5, community reintegration domain).
The current state of acute rehabilitation care for children with traumatic brain injury is variable across different quality-of-care indicators addressing neurobehavioral and psychosocial needs and facilitating community reintegration of the patient and the family. Individual rehabilitation facilities demonstrate inconsistent adherence to different indicators and inconsistent performance across different care domains.
研究与以家庭为中心的护理、神经行为和心理社会需求管理以及创伤性脑损伤后社区再融入相关的儿科住院康复护理过程中的变化。
来自美国地理区域多样化的 9 个急性康复设施。
共 174 名创伤性脑损伤儿童。
回顾性图表审查。
护理指标的依从性（推荐护理的次数与指示护理的次数之比）。
在各机构中，（为便于交付而调整后的）依从率范围为 33.6%至 73.1%（95%置信区间，13.4-53.9，58.7-87.4），用于家庭为中心的过程；21.3%至 82.5%（95%置信区间，6.6-36.1，67.6-97.4），用于神经行为和心理社会过程；22.7%至 80.3%（95%置信区间，5.3-40.1，68.1-92.5），用于社区融入过程。在机构内，依从率的标准差较大（24.3-34.9，家庭为中心领域；22.6-34.2，神经行为和心理社会领域；21.6-40.5，社区再融入领域）。
在不同的质量指标中，针对神经行为和心理社会需求以及促进患者和家庭的社区融入，急性康复护理儿童创伤性脑损伤的现状在不同的康复设施之间存在差异。个别康复机构在不同指标上的依从性不一致，在不同的护理领域表现不一致。
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