Improving Trauma Outcomes:A Patient Centered Approach

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Despite substantial improvements over the last two decadesin the organization and delivery of trauma care, severe injuries often result in poor longterm functional outcomes for working age individuals. Several studies have highlighted the limits of medical treatment alone and demonstrated that larger improvements in outcome will only be possible through interventions that also address the psychosocial needs of patients and assist them in self-managing the multi-factorial consequences of their injury. Intervention: It is in this context that the American Trauma Society developed the Trauma Survivor's Network (TSN) Program, a patient centered intervention designed to fill critical gaps in the care and rehabilitation of trauma survivors. The TSN program consists of four integrated components - health care provider training, efficient access to information and referral, a peer support program, and a self management course - linked together through a customized Information Technology application. Objectives: The purpose of this study is to evaluate the TSN. We will: (1) determine the use and satisfaction with services made available through the TSN Program; and (2) evaluate the effectiveness of the TSN Program in improving primary, secondary and intermediary outcomes for trauma patients. Study Design and Participants: The prospective clinical trial will use a pretest-posttest lagged-control design to evaluate the TSN. A total of 324 patients will be enrolled prior to implementation of the TSN at two Level I trauma centers. These individuals will serve as the control groupand their outcomes assessed at 9 months post-injury. Following implementation of the TSN at both trauma centers, a second cohort of 540 patients will be enrolled and followed at 9 months post-injury. These individuals will serve as the intervention group. Outcomes: Primary measures of effectiveness will include: self-reported pain, anxiety, PTSD, depressed mood, and positive mood. Secondary outcome measures include: function, return to usual major activity and quality of life. Improvements in primary and secondary outcomes will result through the impact of the intervention on self efficacy, patient activation and knowledge, catastrophizing and social support. If shown to be effective, the TSN will provide an additional critical component to the care now available in trauma centers throughout the country and ensure comprehensive patient centered trauma management to improve long-term outcomes and quality of life.