Early Effects of the Trauma Collaborative Care Intervention: Results From a Prospective Multicenter Cluster Clinical Trial

被引:25
|
作者
Wegener, Stephen T. [1 ]
Vallier, Heather A. [2 ]
Huang, Yanjie [3 ]
Gary, Joshua L. [4 ]
Pollak, Andrew N. [5 ]
Bosse, Michael J. [6 ]
Archer, Kristin R. [7 ]
Newcomb, Anna B. [8 ]
Jones, Clifford B. [9 ,10 ]
Sietsema, Debra L. [10 ]
Carroll, Eben A. [11 ]
Castillo, Renan C. [3 ]
Collins, Susan C. [3 ]
Frey, Katherine P. [3 ]
Scharfstein, Daniel O. [3 ]
MacKenzie, Ellen J. [3 ]
Hsu, Joseph R. [6 ]
Karunakar, Madhav A. [6 ]
Seymour, Rachel B. [6 ]
Sims, Stephen H. [6 ]
Churchill, Christine [6 ]
Flores, Eileen [6 ]
Hak, David J. [12 ]
Henderson, Corey [12 ]
Mir, Hassan R. [13 ]
Chan, Daniel S. [13 ]
Shah, Anjan R. [13 ]
Steverson, Barbara [13 ]
Achor, Timothy S. [14 ]
Westberg, Jerald R. [14 ]
Choo, Andrew [4 ]
Munz, John W. [4 ]
Galpin, Matthew C. [4 ]
Hymes, Robert A. [8 ]
Porrey, Melissa A. [8 ]
Hendrickson, Sarah [2 ]
Breslin, Mary A. [2 ]
McKinley, Todd O. [15 ]
Gaski, Greg E. [15 ]
Sorkin, Anthony T. [15 ]
Virkus, Walter W. [15 ]
O'Toole, Robert, V [5 ]
Ordonio, Katherine [5 ]
Howe, Andrea L. [5 ]
Zerhusen, Timothy, Jr. [5 ]
Boyce, Robert H. [7 ]
Jahangir, A. Alex [7 ]
Molina, Cesar S. [7 ]
Obremskey, William [7 ]
Sethi, Manish K. [7 ]
机构
[1] Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA
[2] MetroHlth Med Ctr, Cleveland, OH USA
[3] Johns Hopkins Bloomberg Sch Publ Hlth, METRC Coordinating Ctr, Baltimore, MD USA
[4] Univ Texas Hlth Sci Ctr Houston, Houston, TX 77030 USA
[5] Univ Maryland, R Adams Cowley Shock Trauma Ctr, Baltimore, MD 21201 USA
[6] Carolinas Med Ctr, Charlotte, NC 28203 USA
[7] Vanderbilt Univ Sch Med, Nashville, TN USA
[8] Inova Fairfax Hosp, Annandale, VA USA
[9] Orthopaed Associates Michigan, Grand Rapids, MI USA
[10] CORE Inst, Phoenix, AZ USA
[11] Wake Forest Univ, Baptist Med Ctr, Winston Salem, NC 27101 USA
[12] Denver Hlth & Hosp Author, Denver, CO USA
[13] Florida Orthopaed Inst, Tampa, FL USA
[14] Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA
[15] Methodist Hosp, Boston, MA USA
关键词
trauma collaborative care; trauma; patient outcomes; psychosocial outcomes; POSTTRAUMATIC-STRESS-DISORDER; PERCEIVED BARRIERS; OUTCOMES; HEALTH; DEPRESSION; PAIN; SURVIVORS; INJURY; PTSD; PATIENT;
D O I
10.1097/BOT.0000000000001581
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Objectives: To evaluate the impact of the Trauma Collaborative Care (TCC) program's early intervention components on 6-week outcomes. TCC was developed to improve psychosocial sequelae of orthopaedic trauma and includes the Trauma Survivors Network and additional collaborative care services. Design: Prospective, multicenter, cluster clinical trial. Setting: Level I Trauma Centers. Patients: Individuals with high-energy orthopaedic injuries requiring surgery and hospital admission: 413 patients at 6 trauma centers implementing the TCC program and 374 patients at 6 trauma centers receiving usual care. Intervention: TCC early intervention: patient education, peer visits, and coaching calls. Main Outcome Measurements: Pain rating scale, Patient Health Questionnaire-9 depression, Post-Traumatic Stress Disorder Checklist, and self-efficacy for return to work and managing finances. For each outcome, a hybrid Bayesian statistical procedure, accounting for clustering within sites and differences in baseline characteristics between sites, was used to estimate the intention-to-treat (ITT) effect and the effect under full receipt of early intervention components. Results: Sites varied substantially in utilization of intervention components. The posterior estimates of the ITT (full receipt) effect favor TCC for 4 (5) of the 5 endpoints. The posterior probabilities of a favorable (ITT; full receipt) TCC effect were as follows: depression (89%-93%), pain (84%-74%), post-traumatic stress disorder (68%-68%), self-efficacy for return to work (74%-76%), and self-efficacy for managing finances (47%-61%). Conclusions: Results suggest TCC may have a small positive effect on early outcomes, but use of the services was highly variable among sites.
引用
收藏
页码:538 / 546
页数:9
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