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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.
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:
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.
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:
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:
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.
