A Comparative Effectiveness Trial of an Information Technology Enhanced Peer-Integrated Collaborative Care Intervention for US Trauma Care Systems
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 450
- 试验地点
- 1
- 主要终点
- Number of Patients With 1 or More Emergency Department Visits Per Quarter
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inpatient/emergency admission for intentional and/or unintentional injury
- •Score of ≥35 on the PTSD checklist
- •Endorsement of ≥ 1 severe posttraumatic concern
排除标准
- •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
研究组 & 干预措施
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.
干预措施: Peer-Integrated Multidisciplinary Collaborative Care (Behavioral)
Trauma surgery team notification
Trauma surgery team notification of patient emotional distress, with recommendation for mental health inpatient consultation will be the comparator condition.
干预措施: Trauma surgery team notification (Behavioral)
结局指标
主要结局
Number of Patients With 1 or More Emergency Department Visits Per Quarter
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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.
次要结局
未报告次要终点
研究者
Douglas Zatzick
Professor, School of Medicine: Psychiatry, Clinical
University of Washington