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

项目总结/摘要 每年，创伤性伤害影响美国约300万人，造成超过6500亿美元的成本。 许多患者有弹性，情绪恢复良好，但超过20%（每年约60万人）发展为 心理健康问题，如创伤后应激障碍和抑郁症，这两个主要的风险因素，社会 和职业损伤;身体健康和生活质量差;以及生产力，工作和财务损失 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。 这种病人护理质量的差距，加上精神卫生服务的独特障碍， 患者面临的伤害，有必要采取具有成本效益的干预措施，以满足这些患者的需求， 恢复过程的阶段。我们将测试创伤复原力和恢复计划（TRRP），这是一个可扩展的， 可持续的技术强化干预，以支持患有精神疾病的患者的心理健康恢复 经历了创伤性损伤该模式包括教育，风险筛查，以及在 床边（步骤1）;症状自我监测和通过每日短信系统继续教育（步骤 2）;通过聊天机器人或电话进行30天的心理健康筛查（步骤3）;以及在适当的情况下，心理健康 治疗转诊（步骤4）。我们的前期工作为可接受性和可行性提供了强有力的支持 TRRP的：（1）98%的患者在第1步由TRRP工作人员在床边接触登记心理健康随访- 向上，（2）超过2/3的患者注册症状自我监测系统（第2步），以及（3）75%的患者 在30天呼叫中筛选出PTSD或抑郁症阳性的人（步骤3）接受治疗转诊（步骤4）。 TRRP的工作人员迄今已为8,000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精神健康随访服务 考核我们正在南卡罗来纳州的12个创伤中心实施TRRP，其中4个已经完全完成了 这一经验为我们与乔治合作的方法提供了信息 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例患者的强化常规护理，GWU服务于约2000名不同人群 每年创伤患者（15%穿透机制）。参与心理健康服务， 临床和功能结局将在基线后3、6和12个月由经过培训的访谈者进行评估 对学习条件视而不见。将对20名TRRP患者进行定性访谈， 暴力创伤以及15名非洲裔美国人和15名拉丁裔患者经历了非暴力创伤， 外伤这些数据将为TRRP模型的改进以及实施过程提供信息 为未来8个创伤中心的混合实施效果试验做准备。这项工作的主体是 在继续向国家标准和建议迈进的过程中，这对向外地提供信息至关重要。

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.