Improving Outcomes in Acute Rehabilitation for TBI

描述（由申请人提供）：创伤性脑损伤（TBI）的住院康复在很大程度上是一个未区分的黑匣子。研究还没有解决具体的治疗干预或医疗程序对特定类型的患者和损伤是有效的。该项目旨在为脑外伤患者打开急性康复的黑箱，并为临床决策创造复杂的、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）方法对1815名中度至重度TBI患者的康复治疗服务进行表征，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分离康复治疗的特定组成部分，以确定每个组成部分如何以及在多大程度上与结果相关。研究的三个主要结果是：(1)功能改善的程度；(2)出院到私人住所（相对于疗养院、医院或其他机构）；(3)停留时间反映的资源。这是9个地理和人口分布不同的医院创伤性脑损伤康复机构和ISIS临床结果研究所之间的合作研究伙伴关系。在病人的整个急性康复住院期间，每个治疗阶段进行的干预措施、提供的医疗程序（包括药物和手术）、护理干预和心理社会服务的详细每日记录都将被记录下来。反映当前实践和现有研究的标准化文件将由参与中心的临床医生和研究人员开发。提案的具体目的和相关性。目标1：确定患者个体特征，包括人口统计学特征、脑损伤严重程度和疾病严重程度（并发症和合并症），这些特征与结果的显著差异相关。目标2：确定与更好的结果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：确定治疗相互作用的特定损伤是否与更好的结果相关。

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.