Physicians' Perceptions of Barriers and Facilitators to the Improvement of Healthcare Equity for Children Hospitalized With Traumatic Brain Injury: Preliminary Findings From a Pilot Multicenter Pediatric Trauma Study From the United States

Background and objective Disparities in outcomes for pediatric patients with traumatic brain injuries (TBI) in rural populations and for racial and ethnic minority groups have been documented. In light of this, we examined physician champions' perceptions of healthcare equity for hospitalized children with TBI. Methods We surveyed 10 physician TBI champions at 10 US pediatric trauma centers (PTCs) regarding organizational characteristics, barriers, and facilitators (domains and specific) in terms of improving healthcare equity, and priorities to redress inequities. Results Level I center TBI champions reported more pediatric beds and higher staffing-to-patient ratios while Level II TBI champions reported more pediatric TBI transfers. Across PTCs, the leading specific barriers were lack of access to post-discharge services, lack of staff training, and inadequate staffing. Level I PTCs identified a lack of knowledge about resources while Level II centers identified low hospital staffing numbers and lack of staff training as specific barriers. Across all PTCs, the leading specific facilitators were providers being up to date on skills, treatments, continuing education, team structure and cohesion, and quality improvement and protocol implementation. Across all PTCs, priorities to address barrier domains were staffing, cost and supply constraints, and organizational and structural domains, whereas priorities for facilitator domains were staffing, organizational and structural, and culture of change with variation in priority ranking to address barriers and facilitators by PTC level type. Physician champions identified common and unique barriers and facilitators to providing equitable healthcare for children hospitalized with TBI by PTC level type. Conclusions Respondents across all PTCs reported a set of common leading specific barriers and facilitators. Level I and Level II PTCs reported common specific barriers but more variable specific facilitators. Across all PTCs, the most frequently reported barrier domains were not always of the highest priority to redress.