Collaborative Care for the Older Injured Patient: A Trauma Medical Home

项目摘要 尽管有完全康复的潜力，但令人惊讶的是，很少有老年受伤幸存者能够实现最大的康复。 由于护理服务的分散和缺乏对受伤后功能和生活质量的关注， 在受伤后早期出现心理症状。老年受伤的成年人特别容易死亡， 受伤后的残疾因此，在如何以最佳方式加强 受伤幸存者的康复。这一差距的持续存在是一个重要问题，因为除非 如果没有足够的水，受伤幸存者将继续遭受可能可逆的健康和福祉损害。 这项研究的长期目标是改善受伤患者的健康和护理质量。的 本申请的目的是将协作护理的概念应用于非神经损伤 患者人群。印第安纳州大学医学院的研究人员有超过20年的经验， 发展创新和有效的合作护理模式，将初级护理和专科护理结合起来 医生，以解决复杂的生物心理社会需求的患者与慢性疾病状态，如 痴呆症和抑郁症基于这些成功，一个跨学科的临床研究小组， 印第安纳州大学修订了合作护理模式，以满足受伤幸存者的需求， 积极恢复状态。这种特定的创伤协作护理模式被称为创伤医疗之家（TMH）。 这项建议旨在进行一项随机对照试验，以评估为期6个月的合作 护理干预改善430名50岁及以上创伤幸存者的功能和心理恢复。 本试验的具体目的是：1）评价TMH干预对改善患者体质的能力， 老年损伤幸存者的恢复; 2）评估TMH干预改善 老年创伤幸存者的心理恢复; 3）评估TMH干预的能力，以减少 老年受伤幸存者的医疗费用，并评估TMH干预的有效性成本。的 我们认为，本申请中提出的研究是创新的，因为它代表了一种新的实质性的 脱离现状。以前的合作护理模式侧重于慢性病护理管理， 缺乏快速的适应能力。因为受伤病人的恢复轨迹是动态的，变化的 很快，这项提案的创新与向护理协调员提供实时反馈有关， 将允许护理协调员调整损伤特定的协作护理协议，以满足 在受伤后的动态恢复期内，这一贡献将是巨大的，因为 创伤医疗之家在全国创伤中心和创伤系统中的广泛应用可能导致 改善老年受伤患者的健康状况，提高受伤后护理质量。改善身体健康 和较少的心理症状，可能会导致更好的整体功能能力，增加的能力， 重返工作岗位，减少对家庭、社会和医疗资源的依赖。

Project Summary Despite the potential for full recovery surprisingly few older injury survivors are able to realize maximal recovery of function and quality of life after injury due to fragmentation of care delivery and lack of focus on psychological symptoms in the early post-injury period. Older injured adults are at particular risk of death and disability after injury. Thus, a fundamental gap in knowledge exists regarding the best way to enhance the recovery of injury survivors. The continued existence of this gap is an important problem because unless it is filled, injury survivors will continue to suffer from potentially reversible impairments of health and well-being. The long-term goal of this line of research is to improve the health and quality of care for injured patients. The objective of this application is to apply the concepts of collaborative care to the non-neurologically injured patient population. Indiana University School of Medicine researchers have over 20 years of experience developing innovative and effective collaborative care models that integrate with primary care and specialty physicians to address the complex biopsychosocial needs of patients with chronic disease states, such as dementia and depression. Based on these successes, an interdisciplinary team of clinical investigators at Indiana University revised the collaborative care model to meet the needs of injury survivors who are in an active recovery state. This injury specific collaborative care model is called the Trauma Medical Home (TMH). This proposal aims to conduct a randomized controlled trial to evaluate the efficacy of a 6-month collaborative care intervention in improving the functional and psychological recovery of 430 injury survivors 50 and older. The trial has the following specific aims: 1) Evaluate the ability of the TMH intervention to improve the physical recovery of older injury survivors; and 2) Evaluate the ability of the TMH intervention to improve the psychological recovery of older injury survivors; and 3) Evaluate the ability of the TMH intervention to reduce healthcare costs of older injury survivors and evaluate the cost of effectiveness of the TMH intervention. The research proposed in this application is innovative, in our opinion, because it represents a new and substantive departure from the status quo. Previous collaborative care models focused on chronic care management and they lack rapid adaptability. Because the recovery trajectory of injured patients is dynamic and changes quickly, the innovations in this proposal have to do with providing real-time feedback to a care coordinator that will allow the care coordinator to adjust an injury specific collaborative care protocol to meet the needs of the injured as they move through the dynamic recovery period after injury. This contribution will be significant as broad application of the Trauma Medical Home in trauma centers and trauma systems nationwide could result in better health and improved quality of post-injury care for older injured patients. Improved physical health and fewer psychological symptoms, will likely result in better overall functional ability, the increased ability to return to work and less reliance on family, social, and health care resources.