Improving Health Care Access and Engagement for Veterans and Service Members with TBI Morbidity
Abstract
Overarching Challenge: Research studies suggest individuals with traumatic brain injury have poorer health care experiences and outcomes compared to persons without traumatic brain injury. Persons with traumatic brain injury (TBI) have higher rates of hospital stays, higher rates of injuries, and tend to die younger compared to those who do not have traumatic brain injury. These poor outcomes may be attributed to differences in their healthcare experience. After a TBI, Veterans and Service Members (V/SM) may experience difficulty with thinking abilities (memory, judgement, problem solving, comprehension), physical abilities, and alterations in their behavior that can be problematic. The study team has shown that these changes impact the ability of V/SM’s to access and use high-quality healthcare. The National Academy of Science, Engineering, and Medicine, an independent organization that identifies critical needs in science, recently reported the need for a new field of research that focuses on practical approaches to improve healthcare access (Implementation Science) be conducted for persons with TBI. Background: Applying the practical findings from research into policy and clinical practice is often delayed by decades. To respond to this delay, Implementation Science has emerged as a field of science to move research findings into practical application, at a rapid pace. Practical implementation of research findings has been recognized as a critical approach to support research translation. Like other fields of science, Implementation Science uses a variety of scientific methods (qualitative and quantitative studies) to understand, implement, and examine outcomes associated with promoting the use of evidence-based care (i.e., care that is scientifically recommended). Leaders in science and medicine recognize a strong practical evidence base is needed to guide clinical practice, using innovative approaches to care across different types of healthcare systems, for all types of patients. Persons with TBI and comorbid conditions experience decreased access to evidence-based health care designed to meet their unique needs. Research Plan: The I-HEAL proposal includes four projects with the common goal to address key knowledge gaps and build evidence toward improving access to high-quality care for V/SM with TBI. Project 1 will develop a reminder in the electronic health record to prompt providers to engage healthcare proxies when interacting with persons with thinking difficulties who are at risk for poor participation in their healthcare (engagement). Project 2 will develop a toolkit for individuals with thinking difficulties in need of behavioral or psychological interventions for common disorders that occur alongside TBI such as problems with sleep, psychological health (i.e., PTSD, major depression) and chronic pain. Project 3 will adapt, disseminate, and evaluate readiness to delivery interventions for managing maladaptive behaviors after TBI during inpatient rehabilitation. These behaviors are common early after TBI but healthcare providers lack knowledge and skills in knowing how to best manage these problems resulting in denial of rehabilitation admission, staff injuries, and polypharmacy (too many) for patients. Project 4 will develop clinical and policy decision support products for virtual health resource use for persons with TBI. Collectively, these four projects propose to accomplish the following overarching objectives of the Focused Program Award: (1) adapt existing interventions to promote access and engagement in healthcare; (2) engage stakeholders (all end-users of the science) to maximize uptake of interventions and products; (3) promote research that informs policy and practice through knowledge development, products and products targeting key stakeholders, such as clinicians, Veterans, Service Members, caregivers, policymakers, and other researchers; (4) conduct research and practical
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310621
Entities
People
- Risa Richardson
Organizations
- United States Army
- VA Boston Healthcare System