Characterization, Evaluation, and Implementation of Innovative TBI Intensive Evaluation and Treatment Programs (IETP)

退伍军人健康管理局，物理医学和康复（PM&R）国家 项目办公室开发了五个专业的多发性创伤康复中心（PRC）， 为创伤性脑损伤患者提供全面康复服务。迄今 有效地传播和实施现有的和新出现的研究结果到临床护理 患有TBI的个体仍然有限-特别是那些患有轻度TBI（mTBI）的个体， 能够最大限度地努力在整个PRC提供护理，作为持续学习的医疗保健 系统一个程序已经产生了高知名度和高消费者的需求- TBI密集 评估和治疗计划（IETP），提供基于证据的创新模式 以住院病人的形式提供护理。IETP计划提供捆绑的基于证据的 评估、治疗、转诊和病例管理做法， 轻度TBI和常见合并症的指南。到目前为止，还没有正式的 IETP住宿计划模式的表征或评估，以了解辅导员 以及传播创造更高消费者需求的独特元素的障碍（对于 在一个站点成功的方案）。PM&R的目标 计划办公室是为了促进高消费需求IETP在一个单一的实施 所有VA PRC。这一合作评价的短期目标是充分描述 创新模式（TBI-IETP），量化结果，并了解促进因素和障碍， 在整个医疗系统中推广这个项目。长远目标是全面落实 在所有五个PRC的PM&R护理系统中，该计划的有效组成部分。这 为期三年的并行混合方法合作评价倡议将采用社区 目标1：描述TBI-IETP服务 以及这些服务在五个PRC中的每一个PRC中的实施情况，以确定 适应和规模。在目标1中，我们将使用定性观察、半结构化访谈和 焦点小组，描述PRC成员和国防部代表的经验和建议 实施TBI-IETP;以及患者对TBI-IETP的体验和需求。发现将 确定TBI-IETP核心方面，并确定实施准备情况。目标2：描述 TBI-IETP患者的患者特征、临床服务和结局之间的关系 创伤性脑损伤在多个结果领域，包括恢复的轨迹。在 目标2：我们将使用从每个研究中心的TBI-IETP参与者收集的主要数据， 描述长期结局和患者对治疗的满意度，以及次要数据， 定量表征患者级和护理系统级数据。调查结果将评估 TBI-IETP组件的临床影响。目标3：制定和交付实施行动手册 支持TBI-IETP在各现场的全面实施，以促进采用有效的TBI-IETP 多创伤护理系统的实践。在目标3中，我们将对目标1和目标2数据进行三角测量， 与合作伙伴分享数据调查结果，并制定TBI-RCM实施行动手册。的 评估的行动手册产品将支持TBI-IETP在各研究中心的长期实施。

The Veterans Health Administration, Physical Medicine and Rehabilitation (PM&R) National Program Office developed five specialty Polytrauma Rehabilitation Centers (PRC) to provide comprehensive rehabilitation services for persons with traumatic brain injury (TBI). To date effective dissemination and implementation of extant and emerging findings into clinical care for individuals with TBI remains limited– specifically those with mild TBI (mTBI), restricting the VA’s ability to maximize efforts to deliver care across the PRCs as a continuous learning healthcare system. One program has yielded high visibility and high consumer demand – TBI Intensive Evaluation and Treatment Program (IETP), an innovative modality for delivering evidence-based care in a residential, inpatient format. IETP programs provide bundled evidence-based assessment, treatment, referral, and case management practices in concordance with existing guidelines for mild TBI and common co-occurring comorbidities. To date, there has been no formal characterization or evaluation of the IETP residential program modality to understand facilitators and barriers to spread the unique elements that create higher consumer demand (for the successful program at one site) across the system of care. The goal of the PM&R National Program Office is to facilitate the implementation of the high consumer demand IETP at a single site to all VA PRCs. The short-term goal of this partnered evaluation is to fully characterize the innovative modality (TBI-IETP), quantify outcomes, and understand the facilitators and barriers to spread the program across the system of care. The long-term goal is to fully implement the effective components of the program across the PM&R system of care at all five of the PRCs. This three-year concurrent mixed-method partnered evaluation initiative will employ a Community Based Participatory Approach to conduct the following aims: Aim 1: Describe TBI-IETP services and state of implementation of these services in each of the five PRCs to identify opportunities for adaptation and scale. In Aim 1, we will use qualitative observations, semi-structured interviews and focus groups to describe PRC members and DoD representatives’ experiences and suggestions for implementing TBI-IETP; and patient’s experiences and needs with TBI-IETP. Findings will identify TBI-IETP core aspects and identify implementation readiness. Aim 2: Characterize the relationship between patient characteristics, clinical services and outcomes for TBI-IETP patients with traumatic brain injury across multiple outcome domains, including trajectories of recovery. In Aim 2 we will use primary data collection from TBI-IETP participants at each site to best characterize long-term outcomes and patient satisfaction with treatment, and secondary data to quantitatively characterize patient level and care system level data. Findings will evaluate the clinical impact of TBI-IETP components. Aim 3: Develop and deliver an implementation playbook to support TBI-IETP full implementation at sites to promote adoption of effective TBI-IETP practices across the polytrauma system of care. In Aim 3, we will triangulate Aim 1 and 2 data to share data findings with partners and develop an TBI-RCM implementation playbook. The playbook products from evaluation will support TBI-IETP implementation at sites over time.