3089 — Coordinating Care for Mild Traumatic Brain Injury: A Mixed-Methods Analysis of Polytrauma Care Experiences
Smith BM, Hogan TP, Saban KL, Evans CT, Stroupe KT, St.Andre JR, Miskevics S, and Steiner ML, Edward Hines Jr. VA Hospital;
VA’s program for evaluating Veterans for mild traumatic brain injury (mTBI) includes a clinical reminder to conduct a screen and a comprehensive evaluation for those who screen positive. Subsequent consults may be scheduled across different clinics and Veterans may see many healthcare providers as treatment plans are established, emphasizing the need for effective coordination of care. Utilizing a mixed methods approach, the objectives of this study were to identify barriers to coordination in the assessment and care of mTBI, and strategies used by polytrauma care team (PCT) members to promote coordination.
This cross-sectional, online survey was conducted of PCT members in 2010. Using national VA email distribution lists, 743 eligible participants were identified and 232 surveys were completed. Semi-structured, audio-recorded telephone interviews were subsequently conducted with a purposeful sample of 25 PCT members located at facilities across the country.
Survey respondents reported working within polytrauma clinical support teams (32%), network sites (31%), rehabilitation centers (18%), and other types of facilities (18%), occupying such roles as care coordinators, psychologists, social workers, and physicians. The sample of interview participants was comparable. Access to military records (64%) and lack of time (58%) were the most frequently reported system-related barriers on the survey. Missed appointments (87%) and concurrent mental health issues (74%) were the most frequently reported patient-related barriers. The interviews highlighted the reasons for and interplay of these barriers, including why missed appointments are common and their rippling effects on workflow across clinics. Participants reported various local strategies to improve coordination, including scheduling same-day appointments and promoting better communication around specialty consults.
PCT members encounter barriers in their efforts to coordinate the care of Veterans undergoing assessment and treatment for mTBI. Although they implemented different strategies to improve coordination at their facilities, limited structures and processes seemed to exist to support their efforts.
This study highlights the importance of identifying best practices and implementation strategies for coordinating mTBI care. These findings are informing the design of a QUERI project focused on using telehealth for diagnosis and management of mTBI.