Patient Engagement in a Technology-Enhanced, Stepped-Care Intervention to Address the Mental Health Needs of Trauma Center Patients
Patient Engagement in a Technology-Enhanced, Stepped-Care Intervention to Address the Mental Health Needs of Trauma Center Patients
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DOI：
10.1016/j.jamcollsurg.2020.03.037
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发表时间：
2020-08-01
影响因子：
5.2
通讯作者：
Fakhry, Samir M.
中科院分区：
文献类型：
--
作者：
Ruggiero, Kenneth J.;Davidson, Tatiana M.;Fakhry, Samir M.
背景：每年，在美国创伤中心接受治疗的400,000多名成年人中，创伤后应激障碍、抑郁或两者兼而有之的人在受伤后的第一年发生。然而，很少有创伤中心监测和解决心理健康恢复问题，而且现有项目的评估有限，结构变化很大。需要更多的研究来指导建立此类计划的努力，并为国家标准和建议提供信息。STUDY设计：本文描述了患者参与分级护理服务以满足患者的心理健康需求。在我们的I级创伤中心住院至少24小时的创伤激活患者在出院前被问询。患者在床边接受教育(步骤1)，通过30天的短信工具监测症状(步骤2)，在受伤后约30天进行电话筛查(步骤3)，并在适当的情况下进行心理健康治疗转介和治疗(步骤4)。结果：在33个月的时间里，我们在地板上接触并教育了1122名患者(56%)。在这些患者中，1,096名患者(98%)参加了我们的计划，并同意进行30天的后续心理健康筛查。我们对676名患者进行了为期30天的筛查，其中243名(36%)患者的创伤后应激障碍和/或抑郁筛查呈阳性。在毕业到步骤4的243名患者中，大多数人接受了治疗转介(68%)或已经接受了提供者的服务(7%)。在接受转诊的患者中，66%的患者倾向于家庭远程健康。结论：这项工作证明了循证、技术增强、分步护理干预的可行性，以满足创伤中心患者的心理健康需求。需要采取策略，以达到更高比例的患者进行随访。我们建议创伤中心进行测试并采用广泛的方法，以确保最佳的长期患者结果。(C)2020年由美国外科医师学会主办。由Elsevier Inc.出版。保留所有权利。)
BACKGROUND: Annually, post-traumatic stress disorder, depression, or both, develop in the first year after injury in more than 400,000 adults treated in US trauma centers (>= 20%). Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations.STUDY DESIGN: This article describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma-activation patients admitted to our Level I trauma center for at least 24 hours were approached before discharge. Patients were provided education in person at the bedside (step 1), symptom monitoring via a 30-day text-messaging tool (step 2), telephone screening approximately 30 days post injury (step 3), and, when appropriate, mental health treatment referrals and treatment (step 4).RESULTS: We approached and educated 1,122 patients (56%) on the floor during a 33-month period. Of these, 1,096 patients (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of these patients screened positive for post-traumatic stress disorder and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals.CONCLUSIONS: This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes. ((C) 2020 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)