Improving Outcomes in Acute Rehabilitation for TBI

描述（由申请人提供）：创伤性脑损伤（TBI）的住院患者康复在很大程度上被研究为未分化的黑匣子。研究尚未解决哪些特定的治疗干预或医疗程序对特定类型的患者和损伤有效。该项目旨在为TBI患者打开急性康复的黑匣子，并为临床决策创建复杂的，基于结果的工具。这项为期5年的研究将使用临床实践改进（CPI）方法来描述1，815名中度至重度TBI患者的康复治疗服务，并评估这些治疗对TBI康复结果的影响，控制患者特征和损伤和疾病严重程度的差异。CPI将康复治疗的特定组成部分分离出来，以确定每个组成部分如何以及在何种程度上与结果相关。讨论的三个主要结局是：（1）功能改善的程度;（2）出院到私人住宅（与疗养院、医院、其他机构环境相比）;（3）住院时间反映的资源。这是九个地理和人口统计学上不同的医院TBI康复设施和ISIS临床结果研究所之间的合作研究伙伴关系。在患者的整个急性康复期间，将记录每个疗程中进行的干预措施、提供的医疗程序（包括药物和手术）、护理干预措施和心理社会服务的详细每日记录。参与中心的临床医生和研究人员将制定反映当前实践和现有研究的标准化文件。该提案的具体目标和与公共卫生的相关性是：目标1：识别个体患者特征，包括人口统计学、脑损伤的严重程度和疾病的严重程度（并发症和合并症），与结局的显著变化相关。目标二：识别与更好结局相关的医疗程序和治疗干预，或程序和干预的组合，控制患者特征。目的3：确定治疗相互作用引起的特异性损害是否与更好的结局相关。

DESCRIPTION (provided by applicant): Inpatient rehabilitation for traumatic brain injury (TBI) has been studied largely as an undifferentiated black box. Research has not addressed which specific therapy interventions or medical procedures are effective for specific types of patients and impairments. This project proposes to open the black box of acute rehabilitation for individuals with TBI and create sophisticated, outcomes-based tools for clinical decision- making. This 5-year study will use Clinical Practice Improvement (CPI) methodology to characterize rehabilitation therapy services for 1,815 individuals with moderate to severe TBI and evaluate effects of these therapies on TBI rehabilitation outcomes, controlling for differences in patient characteristics and severity of injury and illness. CPI isolates specific components of rehabilitation treatments to determine how, and to what degree, each component is associated with outcomes. Three primary outcomes addressed are: (1) extent of functional improvement; (2) discharge to a private residence (versus nursing home, hospital, other institutional setting); and (3) resources reflected in length of stay. This is a collaborative research partnership among nine geographically and demographically diverse hospital-based TBI rehabilitation facilities and the ISIS Institute for Clinical Outcomes Research. Detailed, daily documentation of interventions performed in each therapy session, medical procedures delivered including medications and surgeries, nursing interventions, and psychosocial services will be recorded for a patient's entire acute rehabilitation stay. Standardized documentation that reflects current practice and existing research will be developed by clinicians and researchers from the participating centers. Specific aims of the proposal and relevance to.public health are: Aim 1: Identify individual patient characteristics, including demographics, severity of brain injury, and severity of illness (complications and comobordities), associated with significant variation in outcomes. Aim 2: Identify medical procedures and therapy interventions, or combinations of procedures and interventions, that are associated with better outcomes, controlling for patient characteristics. Aim 3: Determine whether specific impairment by treatment interactions are associated with better outcomes.