IT Enhanced Peer Integrated Collaborative Care for US Trauma Care Systems

Not Applicable

Completed

Conditions: Physical Injury
PTSD

Interventions: Behavioral: Trauma surgery team notification
Behavioral: Peer-Integrated Multidisciplinary Collaborative Care

Registration Number: NCT03569878

Lead Sponsor: University of Washington

Brief Summary: This study evaluates two readily implementable approaches to the delivery of transitional care for injured patients treated emergently in US trauma care systems. The two approaches to be compared are a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists to trauma surgical team notification of patient emotional distress with recommended mental health consultation. The collaborative care intervention will be supported by a novel Emergency Department (ED) health information exchange technology platform.

Detailed Description: Collaborative care models are an established standard of care for treating combined mental health and chronic medical conditions in acute and primary care medical settings. However, very few interventions exist for the acute injury population transitioning between settings. While peer interventionist programs have been instituted for care delivery in many conditions, they have not yet been comprehensively integrated into acute post-injury interventions. Literature reviews support the need for comparative effectiveness trials of health care system interventions targeting high need injured patients with multiple complex mental health and medical comorbidities who are at risk for fragmented post-injury health service utilization. This study evaluates two readily implementable approaches to the delivery of transitional care for injured patients treated emergently in US trauma care systems. The two approaches to be compared are a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists to trauma surgical team notification of patient emotional distress with recommended mental health consultation. The collaborative care intervention will be supported by a novel Emergency Department (ED) health information exchange technology platform.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 450

Inclusion Criteria

Inpatient/emergency admission for intentional and/or unintentional injury
Score of ≥35 on the PTSD checklist
Endorsement of ≥ 1 severe posttraumatic concern

Exclusion Criteria

Patients who required immediate psychiatric intervention
Patients who are not Washington or Oregon State residents
Patients who are currently incarcerated
Patients not speaking Spanish or English

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Trauma surgery team notification	Trauma surgery team notification	Trauma surgery team notification of patient emotional distress, with recommendation for mental health inpatient consultation will be the comparator condition.
Peer-Integrated Multidisciplinary Collaborative Care	Peer-Integrated Multidisciplinary Collaborative Care	The peer-integrated collaborative care intervention includes front-line trauma center staff (e.g., nursing and masters in social work), joined by injured peer interventionists and supervised by an MD (psychiatrist). The collaborative care team will provide case management, behavioral intervention elements, psychopharmacologic medication recommendations as well as 24/7 cell phone coverage for approximately 6 months post-injury. The intervention will be supported by a novel emergency department health information technology platform.

Primary Outcome Measures

Name	Time	Method
Number of Patients With 1 or More Emergency Department Visits Per Quarter	Baseline injury admission to 12-months post-injury follow-up	Number of emergency visits will be assessed using the Emergency Department Information Exchange (EDIE). More emergency visits are indicative of a worse outcome.
Change in Posttraumatic Concern Severity	Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up	The severity of patient described post-injury concerns as rated by patients on a 1 through 5 scale; 1 being not at all concerning and 5 being extremely concerning. Higher scores are indicative of a worse outcome. The concern outcome can either be represented as a mean severity score or as a percentage of patients with one or more severe concerns.
Change in Posttraumatic Stress Disorder (PTSD) Symptoms	Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up	The investigators will use the PTSD Checklist - Civilian (PCL-C). The scoring of the scale ranges from a minimum of 17 to a maximum of 85, with higher scores indicating a worse outcome. The measure can also provide a rating of symptoms consistent with a diagnosis of PTSD.
Change in Functional Status	Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up	The investigators will use the Medical Outcomes Study Short Form healthy survey (MOS Short Form-12/36) physical components summary to assess physical function. The minimum and maximum scores are 0-100 with higher scores representing a better outcome.