Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study

Abstract

Aims

To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU.

Methods

According to Andersen’s model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated.

Results

Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not.

Conclusions

mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.

Keywords:

• Disability
• function
• hospitalization
• healthcare equality
• longitudinal

Acknowledgements

We would like to acknowledge the invaluable contribution of Prof. Efrat Shadmi to the conceptualization and implementation of this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by the Israel National Institute for Health Policy and Health Services Research (NIHP) – Grant number 2017/180.

Notes on contributors

Tal Krasovsky

Dr. Tal Krasovsky, PhD, received a Bachelor of Science in Computer Science and a Master's degree in Physical Therapy from Tel-Aviv University, and her Doctorate in Rehabilitation Science from McGill University in Montreal, under the supervision of Prof. Mindy Levin. She is now a senior lecturer (tenured) at the Department of Physical Therapy at University of Haifa and a researcher at the Pediatric Rehabilitation Department at Sheba Medical Center. Her research deals with rehabilitation of people across the life span and the potential of technology to affect rehabilitation outcomes, focusing on balance and gait.

Sharon Barak

Dr. Sharon Barak specializes in physical activity for people with disability and in clinical exercise physiology. Her post-graduate studies focused on rehabilitation and movement sciences. Currently Dr. Barak teaches at Ben-Gurion University of the Negev and Kaye Academic College of Education, Israel. In Addition, she works in development of rehabilitation and evaluation programs in Sheba Medical Center at Tel Hashomer Hospital, Pediatric Rehabilitation Department.

Miriam Dishon-Berkovits

Dr. Miriam Dishon-Berkovits, PhD, is a senior lecturer in the Faculty of Business Administration at Ono Academic College, Israel. She earned her PhD in psychology from Bar-Ilan University in Israel, specializing in organizational, social and cognitive psychology, and was a post-doctorate fellow at the Department of Psychology at Princeton University. Her current research interests focus on understanding human motivation in various domains of life including wellbeing, work-family interface, and proactive work behavior. Miriam is a regular reviewer for psychology journals and conferences, for which she was awarded certificates of excellence. Miriam has extensive experience in communicating scientific psychological findings to the general audience. Additionally, Miriam is the author of a widely cited psychology column in the popular Hebrew science magazine Galileo as well as a bestselling children's book.

Yaara Sadeh

Dr. Yaara Sadeh, Ph.D., is a licensed social worker who earned her Bachelor of Social Work from the Hebrew University, as well as her Master's and Doctorate degrees from Bar-Ilan University. She worked as a social worker and researcher at The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, and is currently a postdoctoral fellow at Children's Hospital of Philadelphia. Recently completing a Ph.D., she aims to combine her interest in pediatrics with her enthusiasm for research, helping children and their parents cope with traumatic medical events.

Jana Landa

Dr. Jana Landa, MD, Psychotherapist is an expert in Physical Medicine and Rehabilitation with 25 years' experience in Pediatric Rehabilitation and the Head of the Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center and is a Teaching member and a clinical instructor at The Faculty of Medicine, The Tel-Aviv University, Israel.

Amichai Brezner

Dr. Amichai Brezner, MD, is a pediatrician and the former director of the department of pediatric rehabilitation at the Lily and Edmond Safra Children Medical Center at the Sheba Medical Center Ramat -Gan Israel.

Tamar Silberg

Dr. Tamar Silberg, PhD, a licensed Rehabilitation Psychologist and Neuropsychologist, is a researcher at the Pediatric Rehabilitation Department, the Edmond and Lily Safra Children's Hospital, Sheba, Israel and a senior lecturer at the Department of Psychology, Bar-Ilan University, Israel.