Improving Activity and Quality of Life Following Orthopaedic Trauma: The Trauma Collaborative Care
Co-Principal Investigators: Dr. Stephen Wegener and Dr. Ellen MacKenzie
This study will evaluate the effectiveness of Trauma Collaborative Care (TCC) in improving outcomes for patients with severe orthopaedic trauma.
The study uses a multi-site, cluster design to determine the effectiveness of an intervention based on a Trauma Collaborative Care (TCC) model in improving patient outcomes for persons with severe orthopedic trauma and enhancing both patient and provider satisfaction with overall care. The study will also determine the cost and cost-effectiveness of the intervention. Primary outcomes include: patient reported assessments of function, depression and post traumatic stress (PTSD). The study is powered on a binary composite measure of these three patient oriented outcomes. Secondary outcomes include pain, health related quality of life, and return to usual major activity. An intermediate outcome is self-efficacy. Following a baseline assessment during the index hospitalization, all outcomes will be measured at 6 and 12 months following injury.
Despite substantial improvements made over the last two decades in the delivery of acute trauma care, severe orthopaedic injuries often result in significant long-term consequences for otherwise young healthy individuals with many years of productive life yet to live. A growing body of literature points to many factors over and above initial treatment, medical complications and extent of residual physical impairment that influence functional outcomes and quality of life following trauma. Previous studies have demonstrated that long term outcomes are substantially influenced by the patient's economic, social and personal resources. These results strongly suggest that major improvements in functional outcome and quality of life require interventions in the early phases of recovery that both directly address the psychosocial needs of patients and their families and assist providers and patients in managing the multi-factorial consequences of injury.
The present study will build on a decade of work by the investigators and evaluate a collaborative care, multi-modal intervention designed to improve the continuum of acute and post-acute care following major orthopedic trauma. The proposed intervention builds on well supported, innovative health care models indicating that outcomes in complex medical conditions improve when “informed, activated” patients interact with “prepared, proactive practice teams.” These models recognize the need for patients and their families to assume greater responsibility for their care and recovery. Additionally, they call for the health care system and providers to train and support patients and families in these recovery activities.
This study is being funded by DOD CDMRP METRC Consortium Award (W81XWH-10-2-0090).