Reducing Disparities in Concussion Care

A sizable proportion (30%) of pediatric concussion patients experience long-lasting symptoms for months to even years. Prompt access to concussion care specialists can accelerate recovery and improve overall outcomes. Yet access to specialized care is not equally distributed among all concussion patients, especially those experiencing socioeconomic disadvantages. 

The Minds Matter Concussion team at Children's Hospital of Philadelphia is committed to reducing these disparities in pediatric concussion care. Our work in this area aims to identify and address barriers to high-quality and equitable concussion care across key socio-demographic groups. 

Investigating Concussion Care Disparities in Primary Care

With a four-year grant from the Centers for Disease Control and Prevention (CDC), Minds Matter Researchers are identifying disparities in concussion outcomes through 1.) review of the Minds Matter Concussion Registry (an electronic health record-based census of those seen for concussion with the CHOP network) and school re-entry data from BrainSTEPS (a program overseen by the Pennsylvania Departments of Health and Education), 2.) evaluating implementation of primary care-based interventions in urban and suburban practices, and 3.) partnering with urban youth-serving schools and sports programs to improve education and access to concussion care.  

Study Objectives

The objectives of this implementation study are to determine the effectiveness of interventions at the primary care, school, and sport-levels to improve concussion outcomes for all youth, and reduce disparities in those outcomes by addressing barriers for both patients and providers in the access and provision of high-quality, equitable care. Innovative mobile health-based strategies to facilitate care continuity will also be evaluated.

Investigational Plan

This project is pursuing the following aims: 

  1. Identify disparities in concussion outcomes by utilizing CHOP’s Minds Matter Concussion registry and Pennsylvania school re-entry data from the BrainSTEPS program. 
  2. Enhance pediatric concussion care at the Primary Care point of entry by implementing an intervention embedding two tools in the electronic health record for accurate concussion diagnosis/management and risk stratification for specialist referral. The impact of this intervention will be compared between urban and suburban primary care practices within the CHOP network. 
  3. Facilitate referral to specialty concussion care for those at higher risk for delayed recovery by connecting those patients to a nurse navigator that will enhance care handoff from primary to specialty care. 
  4. Improve access to concussion care for urban youth by partnering with schools and sports organizations and implementing educational training with personnel. 

Principal Investigators: Kristy Arbogast, PhD and Christina Master, MD

Partners: University of Pennsylvania (School of Nursing, Wharton School), BrainSTEPS Program, Philadelphia Youth Sport Collaborative

Funding: Centers for Disease Control and Prevention

Foundational Research

Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population

In a retrospective medical record review of patients aged 5 to 18 years old who presented to Primary Care over a 6-month period in 2019 (n=755), researchers confirmed disparities in follow-up concussion care completion, particularly among pediatric patients who are publicly insured and identify as non-Hispanic Black. This study highlights disparities in adherence to concussion care recommendations that could impact recovery trajectories. This study was funded, in part, by the CHOP Center for Pediatric Clinical Effectiveness (now known as Clinical Futures).

Read the CHOP Press Release.

Assault-Related Concussion in a Pediatric Population

This study compared demographic characteristics, medical care, and outcomes among patients with assault-related concussions (ARC) versus sports and recreation–related concussions (SRC). Patients with ARC were less likely to receive a concussion-specific diagnostic evaluation and reported a greater impact on educational outcomes. The findings highlight disparities indicating further needs to examine care and outcomes for youth with ARC.