Enhancing the Transition from Hospital to Home for Patients with Traumatic Brain Injury and Families

摘要 尽管重新入院的风险很高，医疗需求也很复杂，但在 美国适用于中到重度创伤性脑损伤(TBI)患者。中、重度颅脑损伤患者 (65岁)因急诊出院而未住院康复的患者有认知能力， 身体、行为和情绪障碍，影响他们独立管理自己的能力 健康、健康和日常生活活动。活动限制通常会导致家庭参与的增加 管理病人的护理。需求的复杂性与医疗服务的碎片化相结合 对于管理不善的症状、不良健康事件、再入院和较低的 重返工作和学校的可能性。过渡性护理被定义为临床遭遇中的行为 旨在确保为在不同医院之间转院的患者提供协调和连续的医疗服务 地理上接近的位置或护理水平。在经历急性事件的其他患者组中 (例如，中风、心肌梗死)，过渡性护理管理改善了患者和家庭 结果。尽管初步研究表明，创伤性脑损伤患者及其家属希望并可能受益 从支持从急诊医院护理过渡到家庭护理的干预措施，这方面的证据力量 话题很低。到目前为止开发的TBI过渡性护理干预措施在改善功能方面无效 结果，不包括家庭需要。因此，我们研究的目的是首先开发和提炼一种 以患者和家庭为中心的颅脑损伤过渡期护理干预支持中重度颅脑损伤患者 以及他们的家庭照顾者在从急性医院护理过渡回家的过程中。此次干预的目的将是 改善脑外伤患者的功能状态，减轻其家庭照顾者的压力，并指导患者和 向家庭提供与其健康相关目标相一致的适当资源和护理。第二，我们将 检查TBI过渡期护理的可行性和可接受性，并评估其初步疗效 干预。我们的主要结果将是患者出院后8周的功能状态。我们还将 检查出院后8周的二次结局，包括家庭照顾者的压力和准备情况 对于照顾者的角色，以及患者和家庭照顾者的自我效能和医疗保健利用。新的 建议研究产生的知识将指导我们的研究团队设计和实施 NIH R01实施--脑损伤过渡期护理干预的有效性临床试验，并将最终 提升脑外伤患者急诊出院护理和家属护理标准。

ABSTRACT Despite high risks of readmission and complex medical needs, there are no transitional care standards in the U.S. for patients with moderate-to-severe traumatic brain injury (TBI). Patients with moderate-to-severe TBI (age < 65 years) discharged home from acute hospital care without inpatient rehabilitation have cognitive, physical, behavioral, and emotional impairments that affect their abilities to independently self-manage their health, wellness, and activities of daily living. Activity limitations often result in increased family involvement for managing the person’s care. The complexity of needs combined with the fragmentation of healthcare services creates the perfect storm for mismanaged symptoms, adverse health events, readmissions, and a lower likelihood of return to work and school. Transitional care is defined as actions in the clinical encounter designed to ensure the coordination and continuity of healthcare for patients transferring between different locations or levels of care in close geographic proximity. In other patient groups who experience acute events (e.g., stroke, myocardial infarction), transitional care management has led to improved patient and family outcomes. Although preliminary research shows that patients with TBI and families desire and could benefit from interventions to support the transition from acute hospital care to home, the strength of evidence on this topic is low. TBI transitional care interventions developed to date are ineffective in improving functional outcomes and do not incorporate family needs. Thus, the purpose of our study is to first develop and refine a patient- and family-centered TBI transitional care intervention to support patients with moderate-to-severe TBI and their family caregivers during the transition home from acute hospital care. The intervention will aim to improve functional status for patients with TBI, reduce strain for their family caregivers, and direct patients and families to appropriate resources and care that is concordant with their health-related goals. Second, we will examine the feasibility and acceptability and assess the preliminary efficacy of the TBI transitional care intervention. Our primary outcome will be patient functional status at 8 weeks post-discharge. We will also examine secondary outcomes at 8 weeks post-discharge, including family caregiver strain and preparedness for the caregiving role, and patient and family caregiver self-efficacy and healthcare utilization. The new knowledge generated from the proposed research will guide our research team in designing and conducting an NIH R01 implementation-effectiveness clinical trial of the TBI transitional care intervention and will ultimately enhance the standard of care for patients with TBI discharged home from acute hospital care and families.