(798) Caregiver Perceptions of Health Disparities in Pediatric Rehabilitation After Critical Illness

Introduction: Our objective was to understand the caregiver perspectives about disparities regarding pediatric rehabilitation access and outcomes.

Methods: This is the qualitative focus of a mixed-methods prospective cohort study. Data collection included self-reported demographic information, clinical/therapy data via chart review, and caregiver-reported functional status assessment. Descriptive and regression modelling statistical techniques assessed for association between rehabilitation outcomes and social determinants of health. Caregivers were interviewed at enrollment, discharge, and one year from PICU hospitalization. Thematic analysis was conducted post one year interview.

Results: 101 children were enrolled, aged 0.5 to 21 years, with median length of stay of 33 days [IQR 5,129]. Majority patients were either Non-Hispanic White (47%), Non-Hispanic Black (35%), or Hispanic (11%). Most (57%) had public insurance, and were from neighborhoods with medium to high or high social vulnerability (53%). Children with medical complexity were 36% of the population. Prominent themes included: delay to outpatient rehabilitation care, delay to return to functional baseline based on accessibility of care, and disparities in care to children with chronic medical complexity. All children admitted to inpatient rehabilitation (31%) had increased connection to outpatient resources or did not require additional services. A limited number of outpatient rehabilitation clinics accepted public insurance. Children with chronic disability were more likely to need multiple forms of insurance to supplement their high healthcare costs, and were less likely to receive intensive rehabilitation while hospitalized.

Conclusions: Insurance status, socioeconomic status, and chronic medical complexity are significant social determinants affecting rehabilitation outcomes and access from the perspective of caregivers.