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

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

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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.

项目摘要/摘要创伤性脑损伤后的残疾（TBI）显着影响美国西班牙裔儿童。与非 - 西班牙裔孩子，他们的生活质量较低，生活质量，自我保健和沟通技巧3年受伤后；即使出院时没有差异。长期康复改善结果，但是及时的启动是关键，因为大多数功能收益发生在TBI之后3到6个月。父母玩在孩子的康复中起着重要作用。但是，西班牙裔父母面临的障碍可能导致延迟的治疗计划和次优结果。我们开发和飞行员测试了第一个基于理论的西班牙裔儿童及其父母的干预，包括脑损伤教育和门诊导航（第一个BIEN）。基于社会认知理论，第一届BIEN融合了人际教育。通过手机设备传递的视频内容，在过渡期间的门诊导航住院治疗和学校返回期间。第一个BIEN飞行员，确定的可行性和可接受性对于我们的计划，有86％的人参加初步后续护理。我们提出了一个多中心随机控制的试验以测试第一BIEN的有效性，以维持长期遵守康复的依从性并确定其对儿童的功能结果。我们将注册150个亲子二元组；儿童（6-17岁），中等严重的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和中美洲。一个更高的风险组，其教育程度，收入和英语水平是与美国父母在干预措施中随机分配给美国父母的其他西班牙裔群体相比，较低（1）一个面对面的教育会议，使用文化，语言和识字相关的第一本小册子每两周针对孩子的TBI和疗法量身定制的视频评论；（2）三个月的双语门诊导航，建模和教练解决问题技能。注意控制父母会收到一个在人教中使用第一本书小册子，每月的非TBI（夫妇）文本和惯例机构后续护理。主要结果是测量后6个月的治疗依从性通过在集中式急性设施的规定时间进行的随访约会的百分比，社区护理提供者和个人疗法。次要结果是孩子的功能状态使用Promis父母报告措施；而且，父母的健康素养，自我效能和心理健康在出院后的3、6和12个月时测量。儿童的学业表现也将被评估使用学校记录。探索性分析将测试可能的主持人，例如受伤前父母适应；和调解人，例如干预后父母tbi知识，自我效能感，动画和沮丧。我们的研究使用手机设备来评估一种新颖，灵活和可扩展的方法来帮助护理过渡，增加治疗依从性并改善TBI结局。它解决了一个研究的人口研究，可以作为TBI家庭中心干预措施的模型。