# Understanding Barriers to Delivery of Care for Patients with Adult Traumatic Brachial Plexus Injury

> **NIH NIH K23** · WASHINGTON UNIVERSITY · 2020 · $155,123

## Abstract

ABSTRACT
The brachial plexus is the network of nerves that connect the spinal cord to the muscles and skin of the
shoulder, arm, and hand. In a brachial plexus injury (BPI), the nerves are damaged, leading to searing pain,
loss of muscle function, and lack of sensation. While surgical treatment using nerve grafts and nerve transfers
can substantially improve function of the arm, delivery of care for BPI in the United States is inefficient and
suboptimal. BPI patients have expressed frustration with finding a surgeon, receiving a late diagnosis, or
receiving insufficient information about their treatment options. BPI surgeons and researchers typically focus
on the neurologic elements of the disease and recovery process (ie: how strong is one specific muscle?), but
have not paid much attention to other non-neurologic factors that may substantially influence outcomes (such
as a patient's support network, financial situation, insurance stability, and understanding of treatment options).
By gathering perspectives from both patients and surgeons using qualitative research methods, we can assess
how these non-neurologic factors impact care. This will allow us to select the most appropriate manner to
incorporate these factors into prospective BPI outcomes evaluation. These initial qualitative assessments are
critical steps in maintaining a patient-centered, function-oriented focus for research and clinical care.
The overall objectives of this application are two-fold. The first objective is to assess what patients and
surgeons perceive as barriers to BPI care, providing an understanding of which factors need to be assessed in
prospective studies of BPI patients. The second objective is to provide the candidate with detailed, hands-on
training to perform qualitative research. Qualitative methods are ideally suited to study BPI patients, as other
research methods (such as administrative data research or traditional quantitative clinical studies) do not
contain the breadth and depth of detail needed to understand the many factors (including social determinants
of health) that influence outcomes for BPI patients. During this award, the candidate will obtain didactic
training, hands-on experience, and mentorship in qualitative research, which will enable him to become a
mixed-methods clinician-scientist. The candidate intends to combine these research experiences with his
clinical expertise in brachial plexus surgery to obtain his long-term goal: designing a multicenter, prospective
cohort study for BPI patients that assesses the influence of both neurologic and non-neurologic factors on
delivery of care and clinical outcomes.

## Key facts

- **NIH application ID:** 9966887
- **Project number:** 5K23AR073928-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Christopher John Dy
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $155,123
- **Award type:** 5
- **Project period:** 2018-08-01 → 2021-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9966887

## Citation

> US National Institutes of Health, RePORTER application 9966887, Understanding Barriers to Delivery of Care for Patients with Adult Traumatic Brachial Plexus Injury (5K23AR073928-03). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/9966887. Licensed CC0.

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