Traumatic Brain Injury A Roadmap for Accelerating Progress (2022) / Chapter Skim
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8 Roadmap and Recommendations: Creating an Optimized System for TBI
8 Roadmap and Recommendations: Creating an Optimized System for TBI
Pages 163-178
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From page 163... ...
The evidence and testimony reviewed by the committee suggest that many persons with TBI and their families find themselves without continuity of care or the full support needed downstream from an acute brain injury. In addition, as in almost all aspects of U.S.
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From page 164... ...
The importance of BPSE dimensions also requires that a team-based approach be taken to managing TBI care and undertaking research aimed at achieving optimal clinical outcomes. Given the scope, scale, and heterogeneity of TBI, the optimized TBI system envisioned by the committee needs to incorporate a broad range of stakeholders and partners.
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2021. "Introduction to a Learning Health System." Presentation and discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021.
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• Incorporates training for those who assess TBI at the point of injury and those who provide care across the full continuum from acute care through recovery. • Establishes infrastructure for systematic learning and improvement, including enhanced and cross-connected data systems and the incorporation of TBI in efforts to improve the national trauma care system, • Establishes demonstration projects on providing effective continuity of care for persons with TBI.
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From page 167... ...
TBI Classification The currently used classification of TBI as "mild, moderate, or severe" and reliance on the Glasgow Coma Scale to determine which of these categories applies to an individual patient are insufficiently nuanced and discriminating to support TBI treatment and prognosis utilizing the best available knowledge. Initial assessment of a TBI often does not predict the evolution of a person's condition over time or ultimate outcome.
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From page 168... ...
Stronger commitment to and strategies for ensuring quality and continuity of care for all TBI patients, regardless of sex, age, race/ethnicity, socioeconomic status, geographic location, and other individual characteristics, are essential so that who you are and where you live do not determine whether and how you live. To this end, it will be necessary to address variability and gaps in available care guidance and in the implementation of existing guidelines, including their use to guide reimbursement practices (see also Recommendation 6)
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From page 169... ...
Relevant clinical organizations that have been active in TBI guideline development and can be engaged in this effort include the Brain Trauma Foundation, Concussion in Sport Group, American College of Surgeons, American Academy of Neurology, American College of Emergency Physicians, American Congress of Rehabilitation Medicine, Neurocritical Care Society, and others. Awareness and Understanding Too large a fraction of TBI is unrecognized as such, either at the time of injury or as symptoms and signs develop after injury.
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From page 170... ...
National- and state-level patient and family orga nizations should work with clinical communities in primary care, acute care, and rehabilitation to ensure that all TBI patients and families receive anticipatory guidance on expected symptoms and trajectory, steps to decrease the risk of delayed recovery, and available TBI resources. Multiple professionals across the health care enterprise, including emergency medical technicians, physicians, nurses, psychologists, and rehabilitation professionals, need sufficient training and guidance on TBI; however, few clinical training curricula address TBI risk factors, diagnosis, and management in any depth.
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From page 171... ...
ACS also operates a consultation process for trauma systems interested in obtaining guidance.3 The CARF Brain Injury Specialty Program designation or demonstration of equivalent standards operates for provision of integrated and specialized rehabilitation care, while the Joint Commission is the largest accreditor of health care organizations in the United States. A Learning System As discussed above, multiple reports from the National Academies have described the ideal properties of a learning health care system, and TBI care should have those properties.
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The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) TBI Model Systems network, operated under the Department of Health and Human Services' Administration for Community Living, maintains longitudinal data, which are especially relevant to rehabilitation care.
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b. Establish translational research and implementation science centers to undertake col laborative efforts toward improved standardization and clinical care for TBI through out the continuum of care.
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From page 174... ...
health care databases, including longitudinal data on hospital-based care. Numerous professional societies are relevant to TBI care and recovery as well.4 The proposed TBI coalition will also need to include and work closely with patient and family 4 These societies include, but are not limited to, Academy of Rehabilitation Psychology, American Academy of Clinical Neuropsychology, American Academy of Family Physicians, American Academy of Neurology, American Academy of Nursing, American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, American Association of Critical Care Nurses, American Association of Neurological Surgeons, American College of Emergency Medicine, American College of Sports Medicine, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Medical Rehabilitation Providers Association, American Nurses Association, American Occupational Therapy Association, American Physical Therapy Association, American Psychological Association, American Speech-Language-Hearing Association, American Therapeutic Recreation Association, Association for Behavioral and Cognitive Therapies, Association of Rehabilitation Nurses, National Medical Association, and National Association of State Head Injury Administrators.
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From page 175... ...
A process that engages a broad coalition of stakeholders in TBI care and research is critical to enabling the consideration of diverse opinions on necessary actions and metrics, and for ensuring that lessons from impactful research and from efforts that advance infrastructure and improve clinical care are discussed and disseminated. A RESEARCH AGENDA TO ACCELERATE THE EXPANSION OF KNOWLEDGE The following eight areas are among the most urgent priorities for continued and expanded research to address existing gaps in the evidence base for action to improve TBI prevention, care, and recovery.
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H. Expand TBI research in areas with a weak history of TBI focus, including health care quality, health economics, and implementation science research. Better understanding is needed of the scope and economic impact of TBI within health care and within families and the broader community.
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2016. A national trauma care system: Inte grating military and civilian trauma systems to achieve zero preventable deaths after injury.
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