Role of Acculturation in Rehabilitation Outcomes

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1 Role of Acculturation in Rehabilitation Outcomes Brian Im, MD San Jose, CA Saturday Feb. 7, 2015

2 NYU TBIMS System of Care EMS NYC area hospitals Bellevue Hospital Center Level I trauma NYUMC Level II trauma Neurosurgery Neurosurgery Acute Inpatient Acute Inpatient Inpatient Rehabilitation Rusk Inpatient Rehabilitation Rusk Affiliated Sub-acute Outpatient Rehabilitation 2

3 Two Phase Approach to Improving Health Literacy and Disparities among Culturally Diverse Samples of Individuals with TBI 3

4 Overall Objective: To address health disparities and increase health literacy by providing a culturally sensitive and accessible intervention. Hypothesis: The study will increase patient-centered treatment and attempt to improve ongoing participation in rehabilitation following discharge from acute inpatient rehabilitation. Rationale: Individuals from culturally diverse backgrounds are disproportionately at risk for sustaining a TBI, yet only a small percentage are likely to be placed in acute inpatient rehabilitation. The majority of Bellevue s patients are culturally diverse and typically are more socioeconomically disadvantaged. 4

5 Phase 1 Extensive data is currently being collected from Bellevue acute inpatient rehabilitation patients with TBI regarding culture, race/ethnicity, acculturation, family support, trust in healthcare providers, and health and language literacy. Follow up data is also being collected from these patients or their health care providers 3-6 months after discharge as well. The purpose is to delineate modifiable and non-modifiable factors that impact patients return for outpatient treatment after discharge. Specific Aims 1. Develop and gather variables that assess cultural identity, and acculturation, and those factors shown to moderate outcomes in culturally diverse participants. 2. Explore relationship between these variables and retention in rehabilitation after inpatient discharge. 3. Explore which demographic, injury and descriptive variables that predict inclusion into NDB (via informed consent) in individuals from both culturally diverse and non-hispanic White backgrounds. 5

6 Phase 2 A multimedia, multicultural intervention program for TBI will be designed, targeting the three largest populations of racial/ethnic groups on our TBI rehabilitation units with the goal of improving retention in the healthcare system once they are discharged. Specific Aims 1. Determine the impact of the intervention on retention in rehabilitation healthcare following discharge for individuals with TBI from both culturally diverse and non-hispanic White backgrounds. 2. Determine the impact of the intervention on enrollment and retention within the NDB at Form I & II assessments. 3. Determine if the intervention is an effective health literacy tool for culturally diverse populations compared to the historical controls who will not receive the intervention during the first two years of Phase 1. 6

7 Phase 2 Goals of the Intervention: 1. To familiarize patients with the concept of TBI and their status as patients undergoing rehabilitation 2. To remind patients of their goals for rehabilitation, familiarize them with the rehabilitation team members responsible for helping them reach their goals, and remind them of treatment recommendations made by members of their team 3. To educate about issues relevant to living after discharge from rehabilitation (e.g., the importance and benefits of follow up care as prescribed by the team); and 4. To evaluate the efficiency and feasibility of using this intervention among this population to improve compliance and other treatment outcomes. 7

8 Phase 2 Format of the Intervention: 2-4 formal interactive sessions with each patient during their inpatient rehabilitation stay A multimedia and multifaceted presentation with both human and technology elements generated during the development time for Phase 2. Adjustments to the intervention will occur as rehabilitation goals shift and will incorporate both general TBI education as well as concrete steps and measures to follow (including outpatient follow up instructions) The total number of presentations patients receive will vary in proportion to their length of stay (~ 21 days). 8

9 Phase 2 Content of the Intervention: First module ( Orientation ) - orient patients to the fact that they have sustained a TBI and contain concepts about TBI and the role of rehabilitation in facilitating recovery Second module ( My Rehabilitation ) limited and concise individually tailored key points based on therapies the patient is prescribed, individualized goals, and strategies and recommendations important for progress in rehabilitation. Discipline-specific strategies and recommendations (e.g., the need to consistently use assistive devices as prescribed by their physical therapist or the importance of keeping emergency information handy in their notebook). Third module ( After I Leave the Hospital ) - educates patients (and available family) about issues relevant to daily living after discharge from rehabilitation and follow up instructions for after discharge. 9

10 I WANT TO GO BACK TO WORK SO, I NEED TO THINK BEFORE DOING THINGS AND CONTROL MY ANGER TO DO THAT, I SHOULD: 1. STOP AND COUNT TO 3 WHEN I M NOT SURE WHAT TO DO

11 TO THINK BEFORE DOING THINGS STOP AND COUNT TO 3 WHEN I M NOT SURE

12 行 動 前 需 要 想 清 楚 當 你 不 肯 定 時, 你 應 該 停 止, 並 由 一 數 到 三 數 一 二 三

13 PIENSA ANTES DE ACCION PARE Y CUENTE A TRES 3 CUANDO ESTOY NO SEGUERO

14 Thank you

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