Enhancing the Transition From Hospital to Home for Patients With Traumatic Brain Injury and Families
Condition: Brain Injuries, Traumatic; Transitional Care; Family Members; Patients
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries
Study type: Interventional

Summary: 
      Despite high risks of readmission and complex medical needs, there are no transitional care
      standards in the U.S. for patients with moderate-to-severe traumatic brain injury (TBI)
      discharged home from acute hospital care without inpatient rehabilitation. To enhance the
      standard of TBI care, we will develop and refine a patient- and family-centered TBI
      transitional care intervention that addresses specific needs and preferences for patients
      with TBI (age < 65 years) and families and will assess the feasibility, acceptability, and
      preliminary efficacy of the intervention.
    

Detailed description: 
      Despite high risks of readmission and complex medical needs, there are no transitional care
      standards in the U.S. for patients with moderate-to-severe traumatic brain injury (TBI).
      Patients with moderate-to-severe TBI (age < 65 years) discharged home from acute hospital
      care without inpatient rehabilitation have cognitive, physical, behavioral, and emotional
      impairments that affect their abilities to independently self-manage their health, wellness,
      and activities of daily living. Activity limitations often result in increased family
      involvement for managing the person's care. The complexity of needs combined with the
      fragmentation of healthcare services creates the perfect storm for mismanaged symptoms,
      adverse health events, readmissions, and a lower likelihood of return to work and school.
      Transitional care is defined as actions in the clinical encounter designed to ensure the
      coordination and continuity of healthcare for patients transferring between different
      locations or levels of care in close geographic proximity. In other patient groups who
      experience acute events (e.g., stroke, myocardial infarction), transitional care management
      has led to improved patient and family outcomes. Although preliminary research shows that
      patients with TBI and families desire and could benefit from interventions to support the
      transition from acute hospital care to home, the strength of evidence on this topic is low.
      TBI transitional care interventions developed to date are ineffective in improving functional
      outcomes and do not incorporate family needs. Thus, the purpose of our study is to first
      develop and refine a patient- and family-centered TBI transitional care intervention to
      support patients with moderate-to-severe TBI and their family caregivers during the
      transition home from acute hospital care. The intervention will aim to improve quality of
      life for patients with TBI, reduce strain for their family caregivers, and direct patients
      and families to appropriate resources and care that is concordant with their health-related
      goals. Second, we will examine the feasibility and acceptability and assess the preliminary
      efficacy of the TBI transitional care intervention. The primary outcome will be patient
      quality of life at 16 weeks post-discharge. This study will also examine secondary outcomes
      at 16 weeks post-discharge, including family caregiver strain and preparedness for the
      caregiving role, and patient and family caregiver self-efficacy and healthcare utilization.
      The new knowledge generated from the proposed research will guide the research team in
      designing and conducting an NIH R01 implementation-effectiveness clinical trial of the TBI
      transitional care intervention and will ultimately enhance the standard of care for patients
      with TBI discharged home from acute hospital care and families
    

Intervention name(s): BETTER Transitional Care Intervention
Intervention type(s): Behavioral
Intervention description(s): Patient and family will receive pre- and post-discharge support and education from interventionist.
Intervention model: Single Group Assignment
Intervention model description: 15 patient/family dyads will undergo intervention
Masking: None (Open Label)
Primary purpose: Health Services Research