Prioritizing Quality Improvement for the Treatment of Psychiatric Disturbances Following Traumatic Brain Injury

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 DESCRIPTION (provided by applicant): This K01 application is designed to prepare the applicant for a successful, independently-funded research career applying methods of stakeholder engagement to investigate the epidemiology of trauma, specifically psychiatric disturbances following TBI. Psychiatric disturbances such as depression, anxiety, and post- traumatic stress disorder (PTSD) following traumatic brain injury (TBI) are associated with poorer cognitive and functional recovery and efficacious treatment would likely improve outcomes. The long term goal of the proposed research is to advance the conduct of patient-centered outcomes research on treatment for psychiatric disturbances following TBI to improve the quality of care. The primary objective of this application is to prioritize patient-selected strategies to overcome barriers to receipt of treatment for psychiatric disturbances following TBI. The specific aims are: 1) Assess patient-centered barriers and facilitators of treatments across comparator treatments and patient groups; 2) Evaluate current treatment patterns and comparative safety associated with treatment of psychiatric disturbances following TBI; and 3) Prioritize patient-selected strategies to overcome barriers to the receipt of treatment for specifi comparator treatments and populations. Two approaches will be employed to identify barriers and facilitators of the receipt of treatment for the three most common psychiatric disturbances following TBI (depression, anxiety, and PTSD). I will implement training in methods of patient engagement and work with my PCOR advisory committee and mentors to identify and recruit patient partners, including individuals with TBI, their family members, and healthcare providers. We will use focus groups and interviews to assess patient-centered barriers and facilitators of treatments across comparator treatments and patient groups and identify comparator treatments for psychiatric disturbances for comparative safety analyses. Next, I will quantify disparities in treatment patterns associated with the three most common psychiatric disturbances following TBI and perform comparative safety analyses to identify variation of treatment risk among defined subgroups. Finally, I will work with my PCOR advisory committee to prioritize patient-selected strategies to overcome barriers to the receipt of treatment for psychiatric disturbances following TBI. The proposed research employs the best of qualitative and quantitative approaches to assess the treatment of psychiatric disturbances following TBI. Patients with TBI will form part of a research advisory committee that will be actively engaged throughout the research process and will drive research questions. The significance of this research is that it will improve the quality of care for patients with psychiatric disturbances following TBI by prioritizing patient-selected strategies to overcome barriers to the receipt of treatment, and providing needed information on treatment patterns and safety of current pharmacologic treatments.