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Attending Follow-up Appointments After Pediatric Traumatic Brain Injury

Caregiver-Perceived Barriers and Facilitators

Lever, Kimberly, MA; Peng, Jin, MD, PhD, MS; Lundine, Jennifer P., PhD, CCC-SLP, BC-ANCDS; Caupp, Sarah, MS; Wheeler, Krista K., MS; Sribnick, Eric A., MD, PhD; Xiang, Henry, MD, PhD, MPH

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p E21–E34
doi: 10.1097/HTR.0000000000000433
Pediatric TBI 2019
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Objective: To examine barriers and facilitators for follow-up care of children with traumatic brain injury (TBI).

Setting: Urban children's hospital.

Participants: Caregivers of children (aged 2-18 years) discharged from an inpatient unit with a TBI diagnosis in 2014-2015.

Design: Survey of caregivers.

Main Measures: Caregiver-reported barriers and facilitators to follow-up appointment attendance.

Results: The sample included 159 caregivers who completed the survey. The top 3 barriers were “no need” (38.5%), “schedule conflicts” (14.1%), and “lack of resources” (10.3%). The top 5 identified facilitators were “good hospital experience” (68.6%), “need” (37.8%), “sufficient resources” (35.8%), “well-coordinated appointments” (31.1%), and “provision of counseling and support” (27.6%). Caregivers with higher income were more likely to report “no need” as a barrier; females were less likely to do so. Nonwhite caregivers and those without private insurance were more likely to report “lack of resources” as a barrier. Females were more likely to report “good hospital experience” and “provision of counseling and support” as a facilitator. Nonwhite caregivers were more likely to report “need” but less likely to report “sufficient resources” as facilitators.

Conclusions: Care coordination, assistance with resources, and improvements in communication and the hospital experience are ways that adherence might be enhanced.

Center for Pediatric Trauma Research (Mss Lever, Caupp, and Wheeler and Drs Lundine, Sribnick, and Xiang), Center for Injury Research and Policy (Mss Lever, Caupp, and Wheeler and Dr Xiang), and Research Information Solutions and Innovation (Dr Peng) at The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Neurosurgery (Dr Sribnick) at Nationwide Children's Hospital, Columbus, Ohio; Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio (Dr Lundine); and The Ohio State University College of Medicine, Columbus, Ohio (Dr Xiang).

Corresponding Author: Henry Xiang, MD, PhD, MPH, Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (Henry.Xiang@NationwideChildrens.org).

This study was funded by a grant from the Ohio Department of Public Safety Emergency Medical Services grant program and a US Department of Health and Human Service Health Resources and Services Administration (HRSA) grant (R40/MC 30759). The authors thank the patients of Nationwide Children's Hospital and their families for their contributions to this project.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.headtraumarehab.com).

There are no conflicts of interest.

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