Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain injury.

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 ( < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days ( = .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.