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

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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.