CHOP researchers find differences in how concussion follow-up care is conducted

CHOP researchers find differences in how concussion follow-up care is conducted

Researchers at Children's Hospital of Philadelphia (CHOP) found disparities in the delivery of concussion follow-up care, particularly among pediatric patients who have public insurance and identify as Black, suggesting that barriers to care exist. The findings, recently published in the Journal of Head Trauma Rehabilitation, will help inform research funded by a newly awarded U.S. Centers for Disease Control and Prevention (CDC) grant aimed at addressing disparities in concussion treatment between socioeconomic groups.

Concussions are a major public health problem, with nearly 2 million occurring annually in children and adolescents. While recovery times vary based on a variety of factors, both early detection and adherence to post-injury activity follow-up guidelines have a positive impact on long-term outcomes and recovery time. However, access to care and the ability to meet follow-up recommendations are not equally distributed among all concussion patients, particularly those with socioeconomic disadvantages. This study was designed to determine where disparities exist in concussion care, with a focus on identifying which demographic groups may be most at risk for health care disparities.

In this retrospective study, researchers reviewed medical records of children seen at CHOP primary care clinics to determine whether pediatric concussion patients adhered to doctors' follow-up recommendations and continued treatment until doctors cleared them to return to full activity. The study evaluated disparities in patients' adherence to follow-up recommendations by analyzing data available in the medical record, including race, ethnicity, insurance, age, gender, how the patients were injured and whether the patient sustained repeated head injuries.

The study found that of a total of 755 patients, non-Hispanic black patients and public insurance or self-pay patients were less likely to meet follow-up recommendations compared to non-Hispanic white patients and private patients (70.6% for these two groups). insured patients (83.5% and 82.9%, respectively). After adjusting for age, gender, mechanism of injury, and recurrent injury, non-Hispanic black patients were more than 50% less likely to meet follow-up recommendations and publicly insured patients were 40% less likely to do so compared to their non-Hispanic counterparts. Hispanic white or privately insured peers.

We know from previous research that patients who are unable to adhere to concussion treatment recommendations, particularly those involving activities and active rehabilitation strategies, may have longer recovery times and worse symptoms over time. This study provides us with a foundation to examine the individual and system-level barriers that may prevent adherence to care, which will ultimately inform how we provide targeted approaches and establish more equitable care to reduce disparities among pediatric concussion patients.”

Daniel J. Corwin, MD, MSCE, senior study author, assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and emergency department director of the Minds Matter Concussion Program at CHOP

To address these disparities, Minds Matter Concussion Program researchers recently received a four-year grant from the CDC to identify additional disparities in concussion outcomes. Researchers plan to analyze electronic health records of patients seen within the CHOP network and evaluate the implementation of primary care-based interventions in urban and suburban practices. The aim is to facilitate the accurate diagnosis and treatment of concussions and to identify those who require referral to a specialist. The study will analyze post-concussion school reentry data from the Pennsylvania Department of Health and Education's BrainSTEPS program, while leveraging partnerships with city schools and athletic programs to improve education and access to concussion care.

This recently published study was supported by a pilot grant from the Children’s Hospital of Philadelphia Center for Pediatric Clinical Effectiveness (now known as Clinical Futures). Research reported in this publication was also supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award No. R01NS097549 and through grant funding from the Pennsylvania Department of Health.

Source:

Children's Hospital of Philadelphia

Reference:

Mohammed, FN, et al. (2022) Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. Journal of Head Trauma Rehabilitation. doi.org/10.1097/HTR.0000000000000823.

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