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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3026 — Rehabilitation for TBI Patients with Polytrauma: Results of the Rapid Needs Assessment of the Four Polytrauma Rehabilitation Centers

Friedemann-Sanchez G (CCDOR, PT/BRI QUERI) , Sayer NA (CCDOR, PT/BRI QUERI)

Service members from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) with severe polytrauma and blast related injuries receive inpatient rehabilitation treatment at four designated VA Polytrauma Rehabilitation Centers (PRCs). The complexity and severity of the injuries presents new challenges to the PRCs and their providers. This PRC needs assessment study has five specific aims: to characterize the structures for and processes of care and its variations across sites, to identify innovations in care, to identify providers’ perceptions of barriers and facilitators to care, to identify gaps and needs in both structures and processes to improve patient outcomes.

We used Rapid Assessment Process (RAP) methodology, defined by the use of iterative cycles of data collection and analysis and triangulation by data source, collection instrument, and consensual analysis. Fifty six in-person individual semi-structured interviews were conducted by two investigators with providers from the four PRCs. The purposive sample included one individual per rehabilitation discipline and disciplines used in consultative services. Analysis included a consensus log per interview. All interviews were recorded and transcribed.

Results suggest that polytrauma patients are different from traditional rehabilitation patients demographically (young, military identities, family involvement is intense). Patients have high visibility and political profile; are clinically complex which has down-stream effects on treatment, processes and systems of care, the organization of rehabilitation teams, and on provider stress. To meet polytrauma patients’ needs, PRC providers are adapting treatment protocols and new technologies, are screening for multiple conditions, and are devoting more clinical hours per patient. For PRC providers, work is stressful as well as rewarding. Organizationally, PRCs have adapted by changing their structures and administrative processes, and are coordinating care across systems and services.

Providers have identified unique demographic and clinical characteristics of patients with severe combat injuries. To maximize outcomes, polytrauma patients should be considered hospital patients. Families have needs that require VA attention. Education on the polytrauma system of care and on rehabilitation is required across services and systems.

Results have implications for provider education and identify important areas for future clinical and implementation research, including caregiver burden.

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