Disparities in Disability after Traumatic Brain Injury for Hispanic Children

描述（由申请人提供）：创伤性脑损伤（TBI）是美国儿童死亡和残疾的主要原因。 或政府保险、家庭功能不佳和父母教育水平较低。在一项初步研究中，我们记录了西班牙裔儿童TBI后长期残疾的差异;与非西班牙裔白色（NHW）儿童相比，西班牙裔儿童在受伤后3年的健康相关生活质量、活动参与以及沟通和照顾自己的能力方面的下降幅度更大。目前尚不清楚是否使用康复服务和/或文化和语言障碍促成了记录的差异。我们提出了一个三阶段的研究计划，比较模式和康复服务的利用及其与西班牙裔，NHW和非西班牙裔黑人（NHB）儿童之间的残疾结果的关联的决定因素。我们还将开发和试点测试的可行性和可接受性的文化定制的干预措施，以减少障碍的西班牙裔TBI儿童使用康复服务。该K23奖项的长期目标是让候选人成为弱势群体患者结局和儿科创伤差异研究领域的独立研究人员。K23候选人是华盛顿大学麻醉学系的助理教授。候选人提出了一个为期五年的培训计划，并得到了在伤害结果研究，基于社区的参与性研究，定性方法和少数民族社区干预试验方面具有专业知识的教师导师的支持。华盛顿大学、西雅图儿童医院和哈博维尤伤害预防和研究中心为该奖项提供了出色的机构支持和资源。该研究涉及三项研究。研究1将比较西班牙裔、NHB和NHW TBI儿科患者住院和门诊康复服务的使用情况及其与残疾的关系。研究2将比较三个种族之间使用门诊康复服务的诱发因素和需求因素。研究3将开发和试点测试一种文化定制的干预措施，以减少西班牙裔TBI儿童使用康复服务的障碍。这些研究将扩大我们对TBI儿童护理差异的潜在原因的理解。它将澄清西班牙裔种族在接受康复护理和TBI后残疾的高风险中的作用，独立于社会经济和少数民族地位。它将为一项多中心研究奠定基础，以评估一种针对文化的干预措施，以减少西班牙裔家庭使用康复服务的障碍，这也可以作为其他弱势群体的典范。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the leading cause of death and disability for children in the U.S. Disability after TBI is higher among children with no or government insurance, poor family functioning and lower levels of parental education. In a preliminary study, we documented disparities in long term disability after TBI for Hispanic children; Hispanic compared to non-Hispanic White (NHW) children experience significantly larger reductions in health related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. It is unclear if use of rehabilitation services and/or cultural and language barriers contributed to the documented differences. We propose a three-phase research plan to compare patterns and determinants of utilization of rehabilitation services and its association with disability outcomes between Hispanic, NHW and non-Hispanic Black (NHB) children. We will also develop and pilot-test the feasibility and acceptability of a culturally tailored intervention to reduce barriers for use of rehabilitation services by Hispanic children with TBI. The long term goal of this K23 award is for the candidate to develop as an independent researcher in the area of patient outcomes in vulnerable populations and pediatric trauma disparities research. The K23 candidate is an Assistant Professor in the Department of Anesthesiology at the University of Washington. The candidate proposes a five-year training plan with the support of faculty mentors who have expertise in injury outcomes research, community based participatory research, qualitative methods, and intervention trials in minority communities. The University of Washington, Seattle Children's Hospital, and Harborview Injury Prevention and Research Center provide excellent institutional support and resources for this award. The research involves three studies. Study 1 will compare use of inpatient and outpatient rehabilitation services between Hispanic, NHB and NHW pediatric patients with TBI, and its association with disability. Study 2 will compare predisposing enabling and need factors for use of outpatient rehabilitation services between the three ethnic groups. Study 3 will develop and pilot-test a culturally tailored intervention to reduce barriers fr use of rehabilitation services by Hispanic children with TBI. These studies will expand our understanding of the potential reasons for disparities in the provision of care for children with TBI. It will clarify the role of Hispanic ethnicity in the receipt of rehabilitation care and highe risk of disability after TBI, independent of socioeconomic and minority status. It will lay the groundwork for a multicenter study to evaluate a culturally tailored intervention to reduce barriers for use of rehabilitation services by Hispanic families, which can also serve as a model for other vulnerable populations.