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Early Combined Intervention After Traumatic Injury

创伤后早期联合干预

基本信息

批准号：
8031462
负责人：
DOUGLAS F ZATZICK
金额：
$ 10.17万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-03-01 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8031462
关键词：
Accreditation Acetylcysteine Acute Admission activity Adoption Advisory Committees Age Alcohol consumption American College of Surgeons Area Caring Case Management Cognitive Therapy Combined Modality Therapy Communities Community Services Comorbidity Continuity of Patient Care Data Disasters Doctor of Philosophy Early treatment Effectiveness Evaluation Evidence based intervention Female Goals Guidelines Healthcare Hospitalization Hospitals Hour Individual Injury Inpatients Intervention Investigation Link Measures Medical Medical center Mental Health Mental Health Services New York City Operative Surgical Procedures Outpatients Patient Preferences Patients Pharmaceutical Preparations Policies Post-Traumatic Stress Disorders Primary Health Care Process Randomized Randomized Clinical Trials Readiness Recruitment Activity Rehabilitation therapy Research Services Structure Survivors Symptoms Testing Trauma Triage United States Universities Visit Washington base care episode cost evidence base follow-up functional disability group intervention health care delivery health care service utilization high risk improved indexing injured motivational enhancement therapy prevent psychopharmacologic therapy development trauma centers

项目摘要

DESCRIPTION (provided by applicant): Each year in the United States approximately 2.5 million individuals are hospitalized after sustaining traumatic physical injuries. Within 48 hours after the September 11th 2001 attack, 1,103 injured victims were triaged through 5 New York City acute care centers. Injured patients are at high risk for developing posttraumatic stress disorder (PTSD) and related comorbidities. High quality interventions remain to be developed for injured trauma survivors who begin their care episode as surgical inpatients and are followed up through primary care outpatient visits and community rehabilitation. The goal of this randomized clinical trial is to test the effectiveness of an early intervention that combines evidence-based psychotherapeutic and psychopharmacological treatments with case management. The early combined intervention is hypothesized to reduce PTSD symptoms, improve post-injury functioning, diminish alcohol consumption, and prevent new injuries. Over a 3 year period, 420 injured trauma survivors ages 18 or older will be recruited from the inpatient trauma surgery service of the University of Washington's Harborview Medical Center and randomized to receive the combined intervention or care as usual. Intervention patients will receive care from a trauma center based mental health team that includes 2 front-line RN interventionists as well as supervising MD/PhD consultants. The case management intervention component engages patients in posttraumatic care and also provides continuity of care by linking treatment across surgical, primary care, and community service delivery sectors. The evidence-based component of the combined intervention includes cognitive behavioral therapy and medications targeting PTSD and motivational interviewing targeting alcohol consumption. Evidence-based interventions will be tailored to patients' preferences and will be delivered at critical junctures after the injury in a stepped fashion. 1, 3, 6, 9, and 12 months after the acute care inpatient admission, the 2 groups will be compared on measures of PTSD, functional impairment, alcohol consumption, new injury hospitalizations, and costs. The investigation includes a national advisory committee that will integrate study findings into ongoing policy discussions surrounding the adoption of sustainable acute mental health services for diverse injured survivors of individual and mass trauma.

描述（由申请人提供）：在美国，每年约有 250 万人因遭受身体创伤而住院治疗。 2001 年 9 月 11 日袭击事件发生后 48 小时内，纽约市 5 个急救中心对 1,103 名伤者进行了分类。受伤患者患创伤后应激障碍 (PTSD) 和相关合并症的风险很高。对于受伤的创伤幸存者来说，高质量的干预措施仍有待开发，他们从手术住院患者开始接受护理，并通过初级保健门诊就诊和社区康复进行随访。这项随机临床试验的目的是测试将循证心理治疗和精神药理学治疗与病例管理相结合的早期干预的有效性。假设早期联合干预可以减少创伤后应激障碍症状、改善受伤后功能、减少饮酒并预防新的伤害。在 3 年的时间内，将从华盛顿大学 Harbourview 医疗中心的住院创伤外科服务中招募 420 名 18 岁或以上的受伤创伤幸存者，并随机接受照常的联合干预或护理。干预患者将接受创伤中心心理健康团队的护理，该团队包括 2 名一线 RN 干预师以及医学博士/博士指导顾问。病例管理干预部分让患者参与创伤后护理，并通过将外科、初级护理和社区服务提供部门的治疗联系起来，提供护理的连续性。联合干预的循证部分包括认知行为疗法和针对创伤后应激障碍的药物治疗以及针对饮酒的动机访谈。基于证据的干预措施将根据患者的喜好量身定制，并将在受伤后的关键时刻逐步实施。急性护理住院患者入院后 1、3、6、9 和 12 个月，将比较两组的 PTSD、功能障碍、饮酒量、新伤住院治疗和费用。该调查包括一个国家咨询委员会，该委员会将把研究结果纳入正在进行的政策讨论中，围绕为个人和大规模创伤的各种受伤幸存者提供可持续的急性心理健康服务。