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：
10469490
负责人：
Nathalia Jimenez
金额：
$ 65.12万
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/10469490
关键词：
Acculturation Active Learning Acute Address Adherence Adolescent Affect Ambulatory Care Anxiety Appointment Area Brain Injuries Car Phone Caring Central America Child Child Care Childhood Injury Cognitive Communication Communities Community Healthcare Control Groups Data Devices Education Educational Background Effectiveness Emotional Enrollment Face Family Future Health Services Health care facility Healthcare Hispanic Hispanic Populations Hospitals Immigrant Improve Access Income Individual Injury Inpatients Intervention Knowledge Linguistics Measures Mediator of activation protein 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 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 base bilingualism care providers caregiving community organizations 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.

项目概要/摘要与非创伤性脑损伤 (TBI) 后的残疾对美国西班牙裔儿童的影响显着。西班牙裔儿童，他们的健康相关生活质量、自我护理和沟通能力较低 3 年受伤后；即使出院时不存在差异，长期康复也会有所改善。效果，但及时开始是关键，因为大多数功能改善发生在父母玩 TBI 后 3 至 6 个月。然而，西班牙裔父母面临着巨大的障碍，可能会导致孩子的康复。我们开发并试点测试了第一个基于理论的方法。对西班牙裔儿童及其家长的干预包括脑损伤教育和门诊导航（第一 BIEN）基于社会认知理论，第一 BIEN 整合了面对面的教育，并通过以下内容丰富了内容。通过移动电话设备传送视频内容，并在从住院到门诊护理以及返校期间的第一次 BIEN 试点确定了可行性和可接受性。对于我们的计划和 86% 的初始随访护理出席率，我们建议采用多中心随机对照。试验旨在测试第 1 次 BIEN 维持长期坚持康复的功效，并确定其对我们将招募150名亲子儿童（6-17岁），年龄为中度至17岁。严重 TBI 及其父母，来自 4 个州的 5 个中心，西班牙裔人口主要来自墨西哥中美洲是一个较高风险群体，其教育程度、收入和英语水平为与美国其他西班牙裔群体相比较低随机接受干预的父母将收到 (1) 一次现场教育课程，使用与文化、语言和读写能力相关的第一本 BIEN 小册子，以及根据孩子的 TBI 和治疗情况，每两周进行一次视频回顾；(2) 三个月的双语课程；门诊导航、建模和指导注意力控制家长将获得一项。使用第一本 BIEN 小册子、每月非 TBI（健康儿童）文本和平常的个人教育课程主要结果是出院后 6 个月测量的治疗依从性。按规定时间内在集中急症设施参加后续预约的百分比，社区护理提供者和个体治疗的次要结果是儿童的功能状态。使用 PROMIS 家长报告措施；以及家长健康素养、自我效能和心理健康出院后 3、6 和 12 个月时也会评估儿童的学业表现。使用学校记录来测试可能的调节因素，例如受伤前的父母。文化适应；以及中介因素，例如干预后父母的 TBI 知识、自我效能、焦虑和我们的研究评估了一种使用移动电话设备来帮助缓解抑郁症的新颖、灵活且可扩展的方法。它满足了护理的转变、提高治疗依从性并改善 TBI 的结果。未充分研究的人群，可以作为以高危人群为中心的 TBI 家庭干预的模型。