Researchers: Tamar Silberg^1,4, Miriam Dison-Berkovits², Tal Krasovsky^1,3, Efrat Shadmi³, Amichai Brezner¹, Sharon Barak^1,5,6

Background: Annually, 300 children are hospitalized for rehabilitation in Israel, half of them following brain injuries. The transition back home following discharge may be a crisis for child and family.

Objectives: 1. To describe long-term health resource utilization (HRU) among children post-discharge from rehabilitation
2. To evaluate the effect of personal, family and environmental factors on under-utilization of health resources post-discharge.

Method: A prospective cohort study. Families who were discharged from pediatric rehabilitation (> 1 month) completed questionnaires to assess personal, familial and environmental status. HRU (including Pediatricians, Health professionals, Psychotherapy) were collected via telephone survey after 3-, 6- and 12-months post-discharge .

Findings: Data from 61 families was collected upon discharge. These families were followed at 3 and 6 months, and 46 families were followed for 12-months. HRU was found to be consistent over time, regardless of etiology or other demographic factors. Age and the level of activity limitation were identified as predictors for HRU in physical, occupational and speech therapy, while level of psychological risk was predictive of emotional therapy utilization. Overall, adherence to discharge recommendations was high (70% and over). Boys and children with larger mobility limitations were more likely to overutilize health resources, while older children were more likely to under-utilize them. Reasons for under-utilization often involved bureaucratic and organizational barriers.

Conclusions: The transition to the community following long-term hospitalization is characterized by consistent HRU over time. The current study’s results demonstrate that upon discharge, families who require more intensive care can be identified using a combination of physical and emotional measures.

Recommendations: There is a need for better coordination between hospital and community in the care of families following prolonged hospitalization. These families are an increasingly sensitive population, and proportional provision of health resources in these cases should be considered.

Research end date: 01/2021