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Brain Injury Outpatient Education and Care Navigation

脑损伤门诊教育与护理导航

基本信息

批准号：
10616772
负责人：
Nathalia Jimenez
金额：
$ 64.76万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10616772
关键词：
Acculturation Active Learning Acute Address Adherence Adolescent Affect Ambulatory Care Anxiety Appointment Area Brain Injuries Caring Cellular Phone Central America Child Child Care Childhood Injury Cognitive Communication Communities Community Healthcare Control Groups Data Devices Education Educational Status Effectiveness Emotional Enrollment Exclusion Face Family Future Health Services Health care facility Healthcare Hispanic Hispanic Populations Hospitalization Hospitals Immigrant Improve Access Income Individual Injury Inpatients Institution Intervention Knowledge Linguistics Measures Mediator Medicaid Mental Depression Mental Health Mexico Minority Groups Modeling Not Hispanic or Latino Outcome Outpatients Pamphlets Parents Participant Performance Persons Physical Function Play Population Population Growth Populations at Risk Problem Solving Proxy Randomized Randomized, Controlled Trials Records Recovery Rehabilitation therapy Reporting Research Risk Risk Factors Role Schools Self Care Self Efficacy TBI treatment Testing Time Traumatic Brain Injury Uninsured Work acceptability and feasibility attentional control bilingualism care providers caregiving community organizations comparison control craniofacial disability education planning education resources efficacy testing emotional functioning flexibility follow-up functional gain functional outcomes functional status group intervention health literacy health related quality of life high risk population improved improved outcome intervention effect literacy long-term rehabilitation neurosurgery novel outreach pilot test post intervention primary caregiver primary outcome programs secondary outcome skills social cognitive theory social engagement theories therapy design treatment adherence

项目摘要

PROJECT SUMMARY/ABSTRACT Disability after traumatic brain injury (TBI) significantly affects U.S. Hispanic children. Compared to non- Hispanic children, they have lower health related quality of life, self-care, and communication skills 3 years after injury; even though differences are not present at hospital discharge. Long-term rehabilitation improves outcomes, but timely initiation is key since most functional gains happen 3 to 6 months after TBI. Parents play a significant role in their child’s recovery. However, Hispanic parents face substantial barriers that can result in delayed treatment initiation and suboptimal outcomes. We developed and pilot tested the 1st theory-based intervention for Hispanic children and their parents consisting of Brain Injury Education and outpatient Navigation (1st BIEN). Based on Social Cognitive theory, 1st BIEN integrates in-person education enriched by video content delivered through mobile phone devices, with outpatient navigation during transitions from inpatient to outpatient care and during school return. The 1st BIEN pilot, established feasibility and acceptability for our program and 86% attendance to initial follow-up care. We propose a multicenter randomized controlled trial to test the efficacy of 1st BIEN to maintain long-term adherence to rehabilitation and determine its effect on children’s functional outcomes. We will enroll 150 parent-child dyads; children (6-17 years), with moderate to severe TBI and their parents, from 5 centers in 4 states with Hispanic population predominantly from Mexico and Central America. A higher risk group, whose educational attainment, income and English proficiency are lower compared to other Hispanic groups in the U.S. Parents randomized to the intervention will receive (1) One in-person education session, using the culturally, linguistically and literacy relevant 1st BIEN booklet, plus bi-weekly video reviews individually tailored to the child’s TBI and therapies; and, (2) three months of bilingual outpatient navigation, modeling and coaching problem solving skills. Attention control parents will receive one in person-education session using the 1st BIEN booklet, monthly non-TBI (Well-child) texts and usual institutional follow up care. The primary outcome is treatment adherence at 6 months post-discharge measured by percentage of follow-up appointments attended during the prescribed time at centralized acute facilities, community care providers and individual therapies. Secondary outcomes are functional status of the child using PROMIS parental report measures; and, parental health literacy, self-efficacy and mental health measured at 3, 6, and 12 months after discharge. Children’s academic performance will also be assessed using school records. Exploratory analyses will test possible moderators such as pre-injury parental acculturation; and mediators, such as post intervention parental TBI-knowledge, self-efficacy, anxiety and depression. Our study evaluates a novel, flexible and scalable approach using mobile phone devices to aid transitions of care, increase treatment adherence and improve TBI outcomes. It addresses the needs of an understudied population and can serve as a model for TBI family centered interventions for at risk groups.

项目总结/文摘