Improving outcomes and reducing disparities through integrated primary care-specialty care implementation of the CDC Pediatric Mild TBI Guideline

轻度创伤性脑损伤(Mtbi)是一种常见的儿童期损伤，有可能造成严重的影响。 论学校和体育环境中的功能。早期识别，随后是最新的mTBI护理 证实可改善预后，减少持续性脑震荡后症状(PPCS)的发生率。 目前关于mTBI护理的最佳证据已汇集在疾病预防控制中心的儿科mTBI指南中， 准备通过严格、有计划的实施将其转化为临床护理。心灵的物质震荡 费城儿童医院(CHOP)的计划已经证明了积极的记录 通过实施电子临床决策支持(ECDS)影响儿童脑损伤的护理 嵌入到全网电子健康记录中。该项目的目标是在这一经验的基础上 改善患有多发性脑损伤儿童的预后，并通过将 将目前的指导方针转变为标准护理。第一个目标将旨在了解 通过检查精神物质震荡，目前8000多名儿童mTBI结果的差异 登记，在整个CHOP医疗保健网络中看到的mTBI儿童普查。此外，我们还将评估 通过我们与BrainSTEPS合作的学习结果，BrainSTEPS是由大脑损伤管理的项目 宾夕法尼亚州协会。在第二个目标中，通过我们与印章的持续成功的合作伙伴关系 初级保健网络，我们将利用经过验证的临床预测分数实施指南通知的ECDs (5P风险评分)和有针对性的mTBI体检(视觉前庭检查) 郊区初级保健实践的阶梯式楔形试验。这一努力将量化 改善儿童mTBI预后的指南，包括在#年确定PPCS高危儿童 需要转诊接受专门护理，并通过纳入不同的做法，确保干预措施的有效性 缩小差距。作为试验设计的一部分，城市和郊区初级保健诊所也将参与 在使用智能手机应用执行移动健康(MHealth)干预的新颖实现中 对症状进行生态瞬时评估，以确定那些处于中等风险类别的人将受益 从之前的转介。第三个目标将调查和解决从以下来源获得专门的mTBI护理的障碍 进入保健系统的其他切入点，即城市学校和青年俱乐部体育组织 通过进行定性的半结构化面谈，并为基于以下条件的人员提供mTBI教育 指导方针。实施远程健康运动训练咨询服务创新专线并审核 它对临床结果的影响和缩小差距。该项目建成后，除了产生 关于儿童mTBI结果和差异的新知识，也将产生ECDs的交付成果 指导方针的临床实施，包括改善mHealth和远程保健的新方法 这将有助于提高儿童的生活质量，减少mTBI方面的差距，对儿童的生活产生广泛影响。

Mild traumatic brain injury (mTBI) is a common injury in childhood with the potential to have a substantial impact on function in the school and sports setting. Early recognition, followed by up-to-date mTBI care, has been demonstrated to improve outcomes, reducing the incidence of persistent post-concussive symptoms (PPCS). The current best evidence for mTBI care has been brought together in the CDC’s Pediatric mTBI Guideline, poised to be translated into clinical care via rigorous, planned implementation. The Minds Matter Concussion Program at the Children’s Hospital of Philadelphia (CHOP) has demonstrated a track record of positively impacting the care of children with mTBI via the implementation of electronic clinical decision support (eCDS) embedded in the network-wide electronic health record. The goal of this project is to build on that experience to improve the outcomes of children with mTBI and reduce the disparities in those outcomes by translating the current Guideline into standard care. The first aim will be directed at understanding the specific roots of the current disparities in pediatric mTBI outcomes for over 8000 children by examining the Minds Matter Concussion Registry, a census of children seen for mTBI across the CHOP healthcare network. In addition, we will evaluate school outcomes through our partnership with BrainSTEPS, a program administered by the Brain Injury Association of Pennsylvania. In the second aim, through our ongoing successful partnership with the CHOP Primary Care Network, we will implement Guideline-informed eCDS utilizing a validated clinical prediction score (5P risk score) and targeted mTBI physical examination (visio-vestibular examination) in selected urban and suburban primary care practices in a stepped-wedge trial. This effort will quantify the direct impact of the Guideline on improving pediatric mTBI outcomes, including the identification of children at high risk of PPCS in need of referral for specialized care, and by including diverse practices, the effectiveness of the intervention in reducing disparities. As part of the trial design, an urban and suburban primary care practice will also participate in the novel implementation of a mobile health (mHealth) intervention using a smartphone application to perform ecological momentary assessment of symptoms to identify those in the moderate risk category who would benefit from earlier referral. The third aim will investigate and address barriers to accessing specialized mTBI care from alternative points of entry into the healthcare system, namely urban schools and youth club sports organizations by conducting qualitative semi-structured interviews and providing mTBI education to those personnel based on the Guideline. We will implement an innovative telehealth athletic training consultation service line and examine its impact on clinical outcomes and reducing disparities. This project, when completed, in addition to generating new knowledge about outcomes and disparities in pediatric mTBI, will also produce the deliverables of eCDS for clinical implementation of the Guideline, including novel mHealth and telehealth approaches to improving outcomes and reducing disparities in mTBI, impacting the lives of children broadly.