Improving Trauma Outcomes:A Patient Centered Approach

改善创伤结果：以患者为中心的方法

• 批准号: 7280890
• 负责人: ELLEN J. MACKENZIE
• 金额: $ 41.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7280890
• 关键词: Improving; Trauma; Outcomes; Patient; Centered

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.

尽管过去二十年在组织和交付方面取得了巨大进步 创伤护理、严重伤害往往会导致工作年龄个体的长期功能结果不佳。 几项研究强调了单纯药物治疗的局限性，并表明较大的治疗 只有通过同时解决社会心理问题的干预措施才有可能改善结果 患者的需求并帮助他们自我管理受伤的多因素后果。 干预：正是在这种背景下，美国创伤协会开发了创伤幸存者网络 (TSN) 计划，一项以患者为中心的干预措施，旨在填补患者护理和康复方面的关键空白 创伤幸存者。 TSN 计划由四个集成部分组成 - 医疗保健提供者培训、 有效获取信息和转介、同伴支持计划和自我管理课程 - 相关 通过定制的信息技术应用程序结合在一起。目的：本研究的目的是 评估 TSN。我们将： (1) 确定通过以下方式提供的服务的使用情况和满意度： TSN 计划； (2) 评估 TSN 计划在改善小学、中学的有效性 以及创伤患者的中间结果。研究设计和参与者：前瞻性临床试验 将使用预测-后测滞后控制设计来评估 TSN。共有324名患者入组 在两个一级创伤中心实施 TSN 之前。这些人将作为控制 组并在受伤后 9 个月评估他们的结果。在双方实施 TSN 后 创伤中心将招募第二组 540 名患者，并在受伤后 9 个月进行随访。这些 个人将作为干预小组。结果：有效性的主要衡量标准包括： 自我报告的疼痛、焦虑、创伤后应激障碍、抑郁情绪和积极情绪。次要结果指标 包括：功能、恢复正常主要活动和生活质量。小学和中学的进步 结果将通过干预对自我效能、患者激活和知识的影响而产生， 灾难性的和社会支持。如果证明有效，TSN 将提供额外的关键 成为全国各地创伤中心现有护理的组成部分，并确保全面 以患者为中心的创伤管理，以改善长期结果和生活质量。