INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Majestic Complex (Posters 61-120) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #69 Social Determinants of Health, Access, and Continuity of Care Following Pediatric Concussion Allison Shields, Dell Children's Medical Center, Austin, United States Laura Winstone-Weide, Dell Children's Medical Center, Austin, United States Zachary Wood, Dell Children's Medical Center, Austin, United States Kelly Gettig, Dell Children's Medical Center, Austin, United States Kimberly Mooney, Dell Children's Medical Center, Austin, United States Cynthia Austin, Dell Children's Medical Center, Austin, United States Category: Concussion/Mild TBI (Child) Keyword 1: concussion/ mild traumatic brain injury Keyword 2: minority issues Keyword 3: treatment outcome Objective: Social determinants of health (SDOH) are social, environmental, and economic factors that affect an individual’s health and wellbeing. Factors such as income, education, neighborhood conditions, and race/ethnicity contribute to health disparities via mechanisms such as health behaviors and decreased access to and utilization of healthcare. Previous research in pediatric concussion suggests that both medical (e.g., prior concussion, referral source) and nonmedical (e.g., ethnicity, English proficiency) factors relate to concussion outcomes such as time to initial evaluation in specialty clinics. The present study extended these findings in a diverse youth sample by investigating associations between various SDOH and concussion-related outcomes. Participants and Methods: Participants consisted of 1085 patients referred to the Concussion Clinic at a children’s hospital in the southwestern United States (Mage = 13.17, SDage = 3.42, age range = 2-21 years, 54.7% male). Participants included those with mild Traumatic Brain Injury (mTBI/concussion) defined by Glasgow Coma Scale score = 13-15 and no significant imaging. Exclusion criteria included pre-existing neurological condition or intellectual disability. Primary SDOH variables included patient ethnicity (Hispanic versus non-Hispanic), language dominance (English-only versus bilingual or other language dominance), interpreter use, and insurance status (Medicaid/ uninsured versus private insurance). Primary outcome measures were time between injury and first concussion clinic visit date (i.e., access to care), loss to follow up, and time between injury and medical clearance. Results: Access to care was delayed among patients with Medicaid or no insurance compared to those with private insurance (M = 23.54 vs. M = 19.46 days post-injury; t(1079) = -2.71, p = .007), and among bilingual or non-English speaking patients compared to monolingual English speaking patients (M = 29.58 vs. M = 20.71 days post-injury; t(177) = -3.10, p = .002). Follow up analyses indicated this was largely due to delayed referral to specialty care by both internal and community providers. Specifically, neither insurance status nor language status was significantly associated with time between injury and first concussion clinic visit when controlling for referral time (i.e., time between injury and referral date; βs = 0.03 to 0.04, ps = .071 to .239). Access to care was not significantly different among Hispanic versus non-Hispanic patients, or among patients who used an interpreter versus those who did not. SDOH variables were not significantly associated with medical clearance time or loss to follow up. Conclusions: Results indicate that there are disparities in specialty concussion care access (estimate of 4 -7 days) for patients who do not have private insurance and those whose families are not monolingual English speakers. This appears to be accounted for by delayed referral to specialty care, highlighting a need to further delineate mechanisms underlying delays in the initial referral process for underserved groups. Once patients were engaged in specialty concussion care, the SDOH factors included in this study were not associated with longer time to medical clearance or greater loss to follow up. This emphasizes the importance of efforts by specialty care clinics to provide equitable care and promote patient retention.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #69

Social Determinants of Health, Access, and Continuity of Care Following Pediatric Concussion

Allison Shields, Dell Children's Medical Center, Austin, United States
Laura Winstone-Weide, Dell Children's Medical Center, Austin, United States
Zachary Wood, Dell Children's Medical Center, Austin, United States
Kelly Gettig, Dell Children's Medical Center, Austin, United States
Kimberly Mooney, Dell Children's Medical Center, Austin, United States
Cynthia Austin, Dell Children's Medical Center, Austin, United States

Category: Concussion/Mild TBI (Child)

Keyword 1: concussion/ mild traumatic brain injury
Keyword 2: minority issues
Keyword 3: treatment outcome

Objective:

Social determinants of health (SDOH) are social, environmental, and economic factors that affect an individual’s health and wellbeing. Factors such as income, education, neighborhood conditions, and race/ethnicity contribute to health disparities via mechanisms such as health behaviors and decreased access to and utilization of healthcare. Previous research in pediatric concussion suggests that both medical (e.g., prior concussion, referral source) and nonmedical (e.g., ethnicity, English proficiency) factors relate to concussion outcomes such as time to initial evaluation in specialty clinics. The present study extended these findings in a diverse youth sample by investigating associations between various SDOH and concussion-related outcomes.

Participants and Methods:

Participants consisted of 1085 patients referred to the Concussion Clinic at a children’s hospital in the southwestern United States (Mage = 13.17, SDage = 3.42, age range = 2-21 years, 54.7% male). Participants included those with mild Traumatic Brain Injury (mTBI/concussion) defined by Glasgow Coma Scale score = 13-15 and no significant imaging. Exclusion criteria included pre-existing neurological condition or intellectual disability. Primary SDOH variables included patient ethnicity (Hispanic versus non-Hispanic), language dominance (English-only versus bilingual or other language dominance), interpreter use, and insurance status (Medicaid/ uninsured versus private insurance). Primary outcome measures were time between injury and first concussion clinic visit date (i.e., access to care), loss to follow up, and time between injury and medical clearance.

Results:

Access to care was delayed among patients with Medicaid or no insurance compared to those with private insurance (M = 23.54 vs. M = 19.46 days post-injury; t(1079) = -2.71, p = .007), and among bilingual or non-English speaking patients compared to monolingual English speaking patients (M = 29.58 vs. M = 20.71 days post-injury; t(177) = -3.10, p = .002). Follow up analyses indicated this was largely due to delayed referral to specialty care by both internal and community providers. Specifically, neither insurance status nor language status was significantly associated with time between injury and first concussion clinic visit when controlling for referral time (i.e., time between injury and referral date; βs = 0.03 to 0.04, ps = .071 to .239). Access to care was not significantly different among Hispanic versus non-Hispanic patients, or among patients who used an interpreter versus those who did not. SDOH variables were not significantly associated with medical clearance time or loss to follow up.

Conclusions:

Results indicate that there are disparities in specialty concussion care access (estimate of 4 -7 days) for patients who do not have private insurance and those whose families are not monolingual English speakers. This appears to be accounted for by delayed referral to specialty care, highlighting a need to further delineate mechanisms underlying delays in the initial referral process for underserved groups. Once patients were engaged in specialty concussion care, the SDOH factors included in this study were not associated with longer time to medical clearance or greater loss to follow up. This emphasizes the importance of efforts by specialty care clinics to provide equitable care and promote patient retention.