Developing Capacity to Improve Care Transitions for Injury Patients in Tanzania

摘要： 伤害是一种全球性的健康危机，每年造成600万人死亡，全世界有超过6.5亿人生活在 残疾人。伤害对5至44岁的人有特别的影响，是主要的伤害因素。 低收入和中等收入环境中的残疾原因调整寿命年损失。协助新受伤者的策略 从急性环境向社区过渡的患者， 收入设置。目前尚未在以下人群中使用全面和基于证据的护理过渡策略： 大多数低收入环境，由于各种限制。 每年有超过2000名患者在基利曼哈罗基督教医疗中心（KCMC）接受治疗， 其中59%的人平均逗留10天。急性损伤出院后 住院，成人损伤患者有一系列复杂的并发症，在'五个领域'， 医疗保健管理，包括功能、心理健康、药物滥用、疼痛和合并症 （包括HIV）。在高收入国家，高达79%的受伤患者患有其中一种并发症， 住院后的领域。虽然缺乏数据，但该区域的初步数据表明，艾滋病毒感染率更高， 在受伤人群中比一般公众更常见，可能会使结果恶化。管理健康和 成年受伤患者住院后的社会需求需要一个多学科团队来解决每一个 这些领域。 这一重要项目的目标是建设能力，以改善受伤者的健康和生活质量。 患者，特别是关注我们的五个健康领域，通过（1）理解和解决护理 过渡需求（包括任何与艾滋病毒有关的需求），以及（2）建立一个资源适当的综合 护理过渡战略。最终，我们将建立研究能力， 测试这种干预。通过这个项目的结论，我们将创建一个本地和国际团队， 卫生系统临床研究人员，高质量的伤害登记，描述性的理解率， 已知和新诊断的艾滋病毒以及艾滋病毒患者在急性损伤期间遭受的并发症，以及 试行的循证和资源适当的护理过渡战略，可在一个全面的 有动力的临床试验。这项研究具有巨大的潜力，可以加强KCMC的护理途径， 伤害感染和不感染艾滋病毒的患者，建立务实的医务人员参与临床试验的能力， 改善患者和家属的预后。

Abstract: Injuries are a global health crisis annually causing 6 million deaths and over 650 million people worldwide living with disabilities. Injuries have a particular impact on people between 5 and 44 years of age and are the leading cause of disability adjusted life years lost in low and middle income settings. Strategies to assist newly injury patients in their transition from the acute setting to the community reduce mortality and morbidity in high income settings. Comprehensive and evidence based transition of care strategies are not currently used in most low income settings due to a myriad of limitations. Over 2000 patients annually are seen at Kilimanjaro Christian Medical Center (KCMC) for acute injuries of which 59% are admitted for an average length of stay of 10 days. Upon discharge from an acute injury hospitalization, adult injury patients have a complex array of complications across the ‘five domains’ of healthcare management which include function, mental health, substance abuse, pain, and comorbidities (which includes HIV). In high income countries, up to 79% of injury patients suffer complications in one of these domains post hospitalization. While data is lacking, preliminary data in the region suggests that HIV is more common in the injury population than the general public and could worsen outcomes. Managing the health and social needs of an adult injury patient post hospitalization requires a multidisciplinary team to address each of these domains. The goal of this important project is to build capacity in order to improve the health and quality of life for injury patients, particularly focusing on our five health domains, by (1) understanding and addressing the care transition needs (including any HIV related needs), and (2) creating a resource-appropriate comprehensive care transitions strategy. Ultimately, we will build the research capacity to qualitatively develop and feasibly test this intervention. By the conclusion of this project, we will have created a team of local and international health system clinical researchers, a high quality injury registry, a descriptive understanding of the rates of known and newly diagnosed HIV as well as the complications HIV patients suffer during acute injuries, and an piloted evidence-based and resource-appropriate care transition strategy feasible for implementation in a fully powered clinical trial. There is tremendous potential for this research to strengthen care pathways at KCMC for injury patients with and without HIV, build capacity for pragmatic stakeholder-engaged clinical trials, and improve patient and family outcomes.