Improving Trauma Outcomes:A Patient Centered Approach

尽管在过去二十年中， 创伤护理，严重的伤害往往会导致工作年龄的个人的长期功能结果不佳。 几项研究强调了单纯药物治疗的局限性，并表明， 只有通过同时解决心理社会问题的干预措施，才有可能改善结果。 患者的需求，并帮助他们自我管理他们的伤害的多因素后果。 干预：正是在这种背景下，美国创伤协会开发了创伤幸存者网络 (TSN)计划，一个以患者为中心的干预，旨在填补护理和康复的关键空白， 创伤幸存者TSN方案包括四个综合组成部分--保健提供者培训， 有效地获得信息和转介，同行支持计划，和自我管理课程-链接 通过定制的信息技术应用程序。目的：本研究的目的是 评估TSN。我们将：（1）确定通过以下方式提供的服务的使用情况和满意度 （2）评估TSN计划在改善小学、中学和高中教育方面的有效性。 和创伤患者的中间结果。研究设计和参与者：前瞻性临床试验 将使用前测后测滞后控制设计来评估TSN。共入组324例患者 在两个一级创伤中心实施TSN之前。这些人将作为对照 在伤后9个月时评估其结果。在两个区域实施技术支助网络后， 在创伤中心，将招募第二组540名患者，并在损伤后9个月进行随访。这些 个人将作为干预小组。结果：有效性的主要衡量标准将包括： 自我报告的疼痛、焦虑、PTSD、抑郁情绪和积极情绪。次要结局指标 包括：功能、恢复日常主要活动和生活质量。改善小学和中学教育 结果将通过干预对自我效能、患者激活和知识的影响产生， 灾难和社会支持。如果证明有效，TSN将提供额外的关键 在全国各地的创伤中心提供护理的组成部分，并确保全面 以患者为中心的创伤管理，以改善长期结果和生活质量。

Despite substantial improvements over the last two decadesin the organization and delivery of trauma care, severe injuries often result in poor longterm functional outcomes for working age individuals. Several studies have highlighted the limits of medical treatment alone and demonstrated that larger improvements in outcome will only be possible through interventions that also address the psychosocial needs of patients and assist them in self-managing the multi-factorial consequences of their injury. Intervention: It is in this context that the American Trauma Society developed the Trauma Survivor's Network (TSN) Program, a patient centered intervention designed to fill critical gaps in the care and rehabilitation of trauma survivors. The TSN program consists of four integrated components - health care provider training, efficient access to information and referral, a peer support program, and a self management course - linked together through a customized Information Technology application. Objectives: The purpose of this study is to evaluate the TSN. We will: (1) determine the use and satisfaction with services made available through the TSN Program; and (2) evaluate the effectiveness of the TSN Program in improving primary, secondary and intermediary outcomes for trauma patients. Study Design and Participants: The prospective clinical trial will use a pretest-posttest lagged-control design to evaluate the TSN. A total of 324 patients will be enrolled prior to implementation of the TSN at two Level I trauma centers. These individuals will serve as the control groupand their outcomes assessed at 9 months post-injury. Following implementation of the TSN at both trauma centers, a second cohort of 540 patients will be enrolled and followed at 9 months post-injury. These individuals will serve as the intervention group. Outcomes: Primary measures of effectiveness will include: self-reported pain, anxiety, PTSD, depressed mood, and positive mood. Secondary outcome measures include: function, return to usual major activity and quality of life. Improvements in primary and secondary outcomes will result through the impact of the intervention on self efficacy, patient activation and knowledge, catastrophizing and social support. If shown to be effective, the TSN will provide an additional critical component to the care now available in trauma centers throughout the country and ensure comprehensive patient centered trauma management to improve long-term outcomes and quality of life.