Testing a Scalable Model of Care to Improve Patients’ Access to Mental Health Services after Traumatic Injury

测试可扩展的护理模式，以改善患者在创伤后获得心理健康服务的机会

• 批准号: 10602428
• 负责人: Kenneth J Ruggiero
• 金额: $ 39.53万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10602428
• 关键词: Testing; Scalable; Model; Care; Improve; Testing; Scalable; Model; Care; Improve

PROJECT SUMMARY/ABSTRACT Annually, traumatic injuries affect roughly 3 million people in the US and account for over $650B in costs. Many patients are resilient and recover well emotionally, but over 20% (~600,000 people per year) develop mental health problems such as posttraumatic stress disorder and depression, both major risk factors for social and occupational impairment; poor physical health and quality of life; and lost productivity, work, and financial resources. Most trauma centers do not address the mental health recovery of patients after a traumatic injury. This gap in the quality of patient care, combined with unique barriers to mental health services that traumatic injury patients face, necessitates a cost-effective intervention that meets the needs of these patients at each stage of the recovery process. We will test the Trauma Resilience and Recovery Program (TRRP), a scalable, sustainable technology-enhanced intervention to support the mental health recovery of patients who have experienced a traumatic injury. The model includes education, risk screening, and brief intervention at the bedside (Step 1); symptom self-monitoring and continued education via a daily text messaging system (Step 2); mental health screening at 30 days via chatbot or telephone (Step 3); and, when appropriate, mental health treatment referrals (Step 4). Our previous work has provided strong support for the acceptability and feasibility of TRRP: (1) 98% of patients approached at Step 1 by TRRP staff at the bedside enroll in mental health follow- up, (2) more than 2 in 3 patients enroll in the symptom self-monitoring system (Step 2), and (3) 75% of patients who screen positive for PTSD or depression at the 30-day call (Step 3) accept treatment referrals (Step 4). TRRP staff has provided mental health follow-up to over 8,000 patients to date, only about 400 of whom would have received mental health follow-up services under usual-care conditions based on the results of our needs assessment. We are implementing TRRP in 12 trauma centers in the Carolinas, 4 of which already have fully implemented it. This experience has informed the approach we propose to use in partnership with George Washington University (GWU) hospital. We will conduct a randomized controlled trial with 1-year follow up of TRRP vs. enhanced usual care with 350 patients at GWU, which serves a diverse population of ~2000 traumatic injury patients per year (15% penetrating mechanism). Engagement in mental health services and clinical and functional outcomes will be assessed 3, 6, and 12 months post-baseline by trained interviewers blind to study condition. Qualitative interviews will be conducted with 20 TRRP patients who have experienced violent trauma as well as 15 African American and 15 Latinx patients who have experienced non-violent trauma. These data will inform improvements to the TRRP model as well as the implementation process in preparation for a future hybrid implementation-effectiveness trial with 8 trauma centers. This body of work is critical to informing the field as it continues to move toward national standards and recommendations.

项目摘要/摘要 每年，创伤性伤害影响美国约300万人，成本超过650B美元。 许多患者具有韧性，并在情感上恢复良好，但是超过20％（每年约60万人） 精神健康问题，例如创伤后应激障碍和抑郁症，这是社会的主要危险因素 和职业障碍；身体健康和生活质量差；失去生产力，工作和财务 资源。大多数创伤中心在创伤性受伤后无法解决患者的心理健康恢复。 患者护理质量的这一差距，结合了创伤性心理健康服务的独特障碍 受伤患者面对的，需要一项具有成本效益的干预措施，以满足每个患者的需求 恢复过程的阶段。我们将测试创伤的弹性和恢复计划（TRRP），可扩展， 可持续技术增强干预措施，以支持患者的心理健康恢复 经历了创伤。该模型包括教育，风险筛查和在 床边（步骤1）;症状自我监控和通过每日文本消息系统继续教育（步骤 2）;通过聊天机器人或电话在30天进行心理健康筛查（步骤3）；而且，在适当的时候，心理健康 治疗转诊（步骤4）。我们以前的工作为可接受性和可行性提供了大力支持 TRRP：（1）98％的患者在第1步中受到TRRP员工在床边入学的心理健康跟随的患者 向上，（2）有3个以上的3例患者参加了症状自我监控系统（步骤2），（3）患者中有75％ 谁在30天的呼叫（步骤3）接受治疗转诊（步骤4）筛选为PTSD或抑郁症的阳性阳性。 迄今为止，TRRP员工为8,000多名患者提供了心理健康随访，其中只有400名 根据我们的需求结果，在通常的护理条件下获得了心理健康后续服务 评估。我们正在卡罗来纳州的12个创伤中心实施TRRP，其中4个已经完全拥有 实施了。这种经验已告知我们建议与乔治合作使用的方法 华盛顿大学（GWU）医院。我们将进行一项随机对照试验，并进行一年的随访 TRRP与增强的通常在GWU患者的患者的平时护理，该患者为2000年的多样 每年创伤性损伤患者（15％穿透机制）。从事心理健康服务和 训练有素的访调员将在基线后3、6和12个月评估临床和功能结果 盲目的研究条件。定性访谈将与20名经历过的TRRP患者进行 暴力创伤以及15名非暴力的非裔美国人和15名拉丁裔患者 创伤。这些数据将为TRRP模型的改进以及在 为未来的混合实施效应试验做准备，并与8个创伤中心进行。这个工作是 在该领域继续朝着国家标准和建议迈进时，至关重要的是。