Testing a Scalable Model of Care to Improve Patients’ Access to Mental Health Services after Traumatic Injury

项目摘要/摘要 每年，美国大约有300万人受到创伤伤害的影响，造成的损失超过6500亿美元。 许多患者都很有弹性，情绪恢复得很好，但超过20%(每年约60万人)会发生 心理健康问题，如创伤后应激障碍和抑郁，这两个都是社会的主要风险因素 和职业损害；身体健康和生活质量差；以及生产力、工作和经济上的损失 资源。大多数创伤中心不解决创伤后患者的心理健康恢复问题。 这种患者护理质量的差距，再加上精神卫生服务的独特障碍，给人们带来了创伤 患者面临的伤害，需要一种经济有效的干预措施，以满足每个患者的需求 恢复过程的阶段。我们将测试创伤复原力和恢复计划(TRRP)，这是一个可扩展、 可持续技术增强的干预措施，支持患有以下疾病的患者的心理健康恢复 经历了一次创伤。该模式包括教育、风险筛查和短期干预。 床边(步骤1)；通过日常短信系统进行症状自我监测和继续教育(步骤 2)；通过聊天机器人或电话在30天内进行精神健康筛查(步骤3)；在适当的情况下，精神健康 转诊治疗(步骤4)。我们的前期工作为系统的可接受性和可行性提供了有力的支持 TRRP：(1)在第一步，TRRP工作人员在床边接触的患者中有98%登记了心理健康跟踪- (2)超过2/3的患者参加症状自我监测系统(步骤2)，以及(3)75%的患者 世卫组织在30天的电话中筛查出创伤后应激障碍或抑郁症阳性(步骤3)，接受治疗转介(步骤4)。 到目前为止，TRRP的工作人员已经为8000多名患者提供了心理健康随访，其中只有大约400人会 根据我们的需求结果，在常规护理条件下接受了心理健康跟踪服务 评估。我们正在卡罗莱纳州的12个创伤中心实施TRRP，其中4个已经完全 实施了它。这一经历为我们建议与George合作使用的方法提供了依据 华盛顿大学(GWU)医院。我们将进行一项随机对照试验，随访1年 TRRP与GWU 350名患者的增强常规护理相比，GWU为约2000名不同人群提供服务 每年创伤患者(15%穿透机制)。参与精神健康服务和 临床和功能结果将在基线后3、6和12个月由训练有素的面试者进行评估 对学习状况视而不见。定性访谈将与20名经历过TRRP的患者进行 暴力创伤以及15名非裔美国人和15名拉丁裔患者经历了非暴力 精神创伤。这些数据将为TRRP模式的改进以及#年的实施进程提供信息。 为未来与8个创伤中心进行的混合实施-有效性试验做准备。这项工作的主体是 在该领域继续向国家标准和建议迈进的过程中，为其提供信息至关重要。

PROJECT SUMMARY/ABSTRACT Annually, traumatic injuries affect roughly 3 million people in the US and account for over $650B in costs. Many patients are resilient and recover well emotionally, but over 20% (~600,000 people per year) develop mental health problems such as posttraumatic stress disorder and depression, both major risk factors for social and occupational impairment; poor physical health and quality of life; and lost productivity, work, and financial resources. Most trauma centers do not address the mental health recovery of patients after a traumatic injury. This gap in the quality of patient care, combined with unique barriers to mental health services that traumatic injury patients face, necessitates a cost-effective intervention that meets the needs of these patients at each stage of the recovery process. We will test the Trauma Resilience and Recovery Program (TRRP), a scalable, sustainable technology-enhanced intervention to support the mental health recovery of patients who have experienced a traumatic injury. The model includes education, risk screening, and brief intervention at the bedside (Step 1); symptom self-monitoring and continued education via a daily text messaging system (Step 2); mental health screening at 30 days via chatbot or telephone (Step 3); and, when appropriate, mental health treatment referrals (Step 4). Our previous work has provided strong support for the acceptability and feasibility of TRRP: (1) 98% of patients approached at Step 1 by TRRP staff at the bedside enroll in mental health follow- up, (2) more than 2 in 3 patients enroll in the symptom self-monitoring system (Step 2), and (3) 75% of patients who screen positive for PTSD or depression at the 30-day call (Step 3) accept treatment referrals (Step 4). TRRP staff has provided mental health follow-up to over 8,000 patients to date, only about 400 of whom would have received mental health follow-up services under usual-care conditions based on the results of our needs assessment. We are implementing TRRP in 12 trauma centers in the Carolinas, 4 of which already have fully implemented it. This experience has informed the approach we propose to use in partnership with George Washington University (GWU) hospital. We will conduct a randomized controlled trial with 1-year follow up of TRRP vs. enhanced usual care with 350 patients at GWU, which serves a diverse population of ~2000 traumatic injury patients per year (15% penetrating mechanism). Engagement in mental health services and clinical and functional outcomes will be assessed 3, 6, and 12 months post-baseline by trained interviewers blind to study condition. Qualitative interviews will be conducted with 20 TRRP patients who have experienced violent trauma as well as 15 African American and 15 Latinx patients who have experienced non-violent trauma. These data will inform improvements to the TRRP model as well as the implementation process in preparation for a future hybrid implementation-effectiveness trial with 8 trauma centers. This body of work is critical to informing the field as it continues to move toward national standards and recommendations.