IT Enhanced Peer Integrated Collaborative Care for US Trauma Care Systems

Study Overview
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Brief Summary
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This study evaluates two readily implementable approaches to the delivery of transitional care for injured patients treated emergently in US trauma care systems. The two approaches to be compared are a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists to trauma surgical team notification of patient emotional distress with recommended mental health consultation. The collaborative care intervention will be supported by a novel Emergency Department (ED) health information exchange technology platform.

Detailed Description
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Collaborative care models are an established standard of care for treating combined mental health and chronic medical conditions in acute and primary care medical settings. However, very few interventions exist for the acute injury population transitioning between settings. While peer interventionist programs have been instituted for care delivery in many conditions, they have not yet been comprehensively integrated into acute post-injury interventions. Literature reviews support the need for comparative effectiveness trials of health care system interventions targeting high need injured patients with multiple complex mental health and medical comorbidities who are at risk for fragmented post-injury health service utilization. This study evaluates two readily implementable approaches to the delivery of transitional care for injured patients treated emergently in US trauma care systems. The two approaches to be compared are a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists to trauma surgical team notification of patient emotional distress with recommended mental health consultation. The collaborative care intervention will be supported by a novel Emergency Department (ED) health information exchange technology platform.

Official Title
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A Comparative Effectiveness Trial of an Information Technology Enhanced Peer-Integrated Collaborative Care Intervention for US Trauma Care Systems

Conditions
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Physical Injury, PTSD

Intervention / Treatment
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* Behavioral: Peer-Integrated Multidisciplinary Collaborative Care
* Behavioral: Trauma surgery team notification


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inpatient/emergency admission for intentional and/or unintentional injury Score of ≥35 on the PTSD checklist Endorsement of ≥ 1 severe posttraumatic concern Exclusion Criteria: Patients who required immediate psychiatric intervention Patients who are not Washington or Oregon State residents Patients who are currently incarcerated Patients not speaking Spanish or English

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Peer-Integrated Multidisciplinary Collaborative Care<br>The peer-integrated collaborative care intervention includes front-line trauma center staff (e.g., nursing and masters in social work), joined by injured peer interventionists and supervised by an MD (psychiatrist). The collaborative care team will provide case management, behavioral intervention elements, psychopharmacologic medication recommendations as well as 24/7 cell phone coverage for approximately 6 months post-injury. The intervention will be supported by a novel emergency department health information technology platform. | Behavioral: Peer-Integrated Multidisciplinary Collaborative Care<br>* Case management, behavioral intervention elements, psychopharmacologic medication recommendations and 24/7 cell phone coverage for 6 months post-injury.<br>|
| Active Comparator: Trauma surgery team notification<br>Trauma surgery team notification of patient emotional distress, with recommendation for mental health inpatient consultation will be the comparator condition. | Behavioral: Trauma surgery team notification<br>* Trauma surgery team notification of patient emotional distress, with plan for mental health inpatient consultation will be the comparator condition.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Emergency Department Utilization | Number of emergency visits will be assessed using the Emergency Department Information Exchange (EDIE). More emergency visits are indicative of a worse outcome. | Baseline injury admission to 12-months post-injury follow-up | 
| Change in Posttraumatic Concern Severity | The severity of patient described post-injury concerns as rated by patients on a 1 through 5 scale; 1 being not at all concerning and 5 being extremely concerning. Higher scores are indicative of a worse outcome. The concern outcome can either be represented as a mean severity score or as a percentage of patients with one or more severe concerns. | Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up | 
| Change in Posttraumatic Stress Disorder (PTSD) Symptoms | The investigators will use the PTSD Checklist - Civilian (PCL-C). The scoring of the scale ranges from a minumum of 17 to a maximum of 85, with higher scores indicating a worse outcome. The measure can also provide a rating of symptoms consistent with a diagnosis of PTSD. | Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up | 
| Change in Functional Status | The investigators will use the Medical Outcomes Study Short Form healthy survey (MOS SF-12/36) physical components summary to assess physical function. The minimum and maximum scores are 0-100 with higher scores representing a better outcome. | Baseline injury admission and 1-, 3-, 6-, 9- and 12-months post-injury follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PTSD, Physical Injury, Patient Concerns, Emergency Department Utilization