Health Services Research & Development

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Polytrauma: The Importance of Family Caregivers

November 2012


More than 54,000 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) service members have been wounded in action or killed. Blasts are the most common cause of combat injury. In combat, sources of blast injury can include: artillery, rocket and mortar shells, mines, aerial bombs, improvised explosive devices (IEDs), and rocket-propelled grenades. Blast injuries are often polytraumatic, meaning that they affect multiple body systems or organs, which often require long-term care from family caregivers. VA's Polytrauma System of Care strongly advocates family involvement throughout the rehabilitation process. During National Family Caregivers Month, HSR&D highlights research in this vital area.

Patient-and Family-Centered Care within Polytrauma Outpatient Programs

Investigators from the Polytrauma/Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI-QUERI) conducted a web-based survey of clinicians as part of a recent study aimed at identifying gaps in patient-and family-centered care within polytrauma outpatient programs.

Findings indicate that most polytrauma clinicians work with patients to ascertain the appropriate level of family involvement–and that the majority of Interdisciplinary Teams (two-thirds) are committed to meeting with the Veteran and their family members to create individualized goals and plan of care. However, clinicians also reported a number of challenges, such as difficulty engaging some families because they don't attend clinic visits. The next most frequently reported challenges were s lack of time to engage families, and the lack of space to do so. Results from this study also show that clinicians who routinely ask Veterans to identify a friend or family member who can help support the Veteran's traumatic brain injury (TBI)/polytrauma plan of care are more likely to:

  • Provide family members with general information about the Veteran's condition and services;
  • Convey information about the Veteran's status, treatment, and prognosis;
  • Demonstrate behaviors that support and enable families caring for a family member with a chronic health condition; and
  • Treat Veterans and their families as individuals and equals.

Investigators also found that lower rates of implementation of family-centered practices were predicted by clinical role, less experience in TBI/polytrauma, and part-time status with the TBI/polytrauma program.

Findings from this study will be used to develop interventions that mitigate barriers to family care and foster promising practices for involving families in patients' care plans in polytrauma outpatient settings.

Family Care Map

PT/BRI-QUERI also led the development of the "Family Care Map," a web-based tool for staff and family caregivers that describes the inpatient rehabilitation process at VA's Polytrauma Rehabilitation Centers, and how family members can help their loved ones during their inpatient stay. PT/BRI-QUERI defines "family" members as those individuals – related or unrelated – who actively provide emotional, physical, and/or economic support to the Veteran. Members of the family are determined by the patient, or by those individuals who include themselves in the patient's support system.

The Family Care Map has been:

  • Incorporated into the nurse training programs and interdisciplinary plans on polytrauma inpatient units; and
  • Recognized as a valuable resource by VA's Polytrauma Action Committee and the Centers for Ethics, as well as the Government Accountability Office.
  • Additional Research

    PT/BRI-QUERI investigators are conducting other research studies in several key areas of importance to Veterans with polytrauma and blast-related injuries, such as:

  • Understanding and Meeting the Needs of Informal Caregivers to Improve Outcomes for TBI Patients with Polytrauma;
  • Adapting Coordination of Care Measures to Assess Polytrauma Care;
  • Developing a Consensus Vision Screen for Patients with Mild Traumatic Brain Injury;
  • Soldier to Civilian: Intervention to Promote Post-Deployment Reintegration;
  • Tele-rehabilitation for OEF/OIF Returnees with Combat-Related Traumatic Brain Injury;
  • Identifying Potential Demand for VA Rehabilitation Services for OEF/OIF Veterans.
  • Visit the QUERI national website to learn more about this unique quality improvement program with a focus on implementation science, as well as the other nine QUERI Centers.