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

摘要 尽管再入院的风险很高，医疗需求也很复杂，但美国没有过渡性护理标准。 美国对于中度至重度创伤性脑损伤（TBI）患者。中重度TBI患者 (age< 65岁）从急性医院护理出院回家，没有住院康复， 身体，行为和情感障碍，影响他们独立自我管理的能力， 健康、保健和日常生活活动。活动限制往往导致家庭参与增加， 管理人的护理。需求的复杂性加上医疗服务的分散性 为管理不当的症状、不良健康事件、再入院和较低的 返回工作和学校的可能性。过渡期护理的定义是在临床遇到的行动 旨在确保在不同地点之间转移的患者的医疗保健的协调和连续性 在地理上接近的地点或护理水平。在发生急性事件的其他患者组中 (e.g.,中风、心肌梗塞），过渡性护理管理已导致患者和家庭改善 结果。尽管初步研究表明，TBI患者及其家属希望并可能受益 从干预措施到支持从急性医院护理到家庭护理的过渡， 话题低。迄今为止开发的TBI过渡性护理干预措施在改善功能方面无效 结果并不包括家庭需求。因此，我们研究的目的是首先开发和完善一个 以患者和家庭为中心的TBI过渡性护理干预，以支持中重度TBI患者 和他们的家庭照顾者在从急性医院护理过渡回家期间。干预的目的是 改善TBI患者功能状态，减轻其家庭护理人员的压力，并指导患者， 家庭获得与其健康相关目标相一致的适当资源和护理。二是 检查TBI过渡护理的可行性和可接受性，并评估其初步疗效 干预我们的主要结局是患者出院后8周的功能状态。我们还将 检查出院后8周的次要结局，包括家庭照顾者的压力和准备情况 对于照顾者角色，以及患者和家庭照顾者自我效能和医疗保健利用。新 从拟议的研究中产生的知识将指导我们的研究团队设计和进行一项 NIH R01实施TBI过渡护理干预的有效性临床试验，并将最终 提高从急性医院护理出院回家的创伤性脑损伤患者及其家人的护理标准。

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.