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Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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Appendix A: Comparative Effectiveness and Implementation Research for Neurocognitive Disorders: Concepts Relevant to Cognitive Rehabilitation Therapy for Traumatic Brain Injury
Pages 273-282

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From page 273...
... as well as any evidence of harm or safety issues. Thus, subtasks 1 through 3 of the Statement of Task to the committee include requests for analysis of any existing literature that directly compares alternative treatment approaches.
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From page 274...
... * FIGURE A-1 Model for multi-modal/comprehensive CRT.
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From page 275...
... Thus, implementation research not only observes levels of care and barriers to provision of highquality care, but also designs and evaluates policy or health care delivery system interventions that may improve the uptake or delivery of a clinical therapy. In that way, the health benefit of a therapy -- across a population -- is maximally achieved in the context of its value.
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From page 276...
... 276 Higher use of Improved RCT-proven population ion health treatments* s ffu Di Clinical Science and Clinical Quality Translation Translation from Basic Basic Knowledge of Improvement or into "real Neuroscience to Research Potential Value Policy world" Human Studies under Ideal Interventions settings Conditions No Lower, dif fus delayed, or ion inappropriate use of RCT-proven treatments Implementation Comparative Research Effectiveness Research FIGURE A-2 Clinical research continuum.
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From page 277...
... . CRT FOR TBI AND COMORBIDITIES COMMON IN THE MILITARY SETTING The literature reviewed for this report illustrates that TBI occurring in a military context is commonly accompanied by comorbidities, including symptoms of psychological distress and possible co-occurring diagnoses of depression, posttraumatic stress disorder (PTSD)
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From page 278...
... The study addresses pervasive TBI comorbidities through inclusion of a comparator arm in which both cognitive and psychological comorbidities are systematically screened for and addressed in a strategy tailored to the individual. This clinically pragmatic approach recognizes that multiple, applicable, efficacious clinical interventions should be tailored to the problems of the individual, both the primary cognitive domain(s)
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From page 279...
... Such registries go beyond administrative claims data, which typically lack sufficient clinical data on disease severity. Larger, integrated health care delivery systems are creating registries that link administrative claims data with pharmacy data, laboratory data, electronic medical records, and increasingly, patient-reported data collected in a systematic fashion, to minimize missing data on key variables (Paxton et al.
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From page 280...
... , including the congressionally mandated 15-year longitudinal study of TBI outcomes in soldiers being carried out by DVBIC. POTENTIAL OPPORTUNITIES Opportunities for advancing knowledge of what works for CRT in TBI and for efficiently translating that knowledge into health care delivery systems and maximizing health outcomes include the following: • In currently planned DoD and VA registries, purposefully embed the necessary data elements about types of CRT and providers, to prospectively analyze current care patterns and costs, and factors associated with variation (Gliklich and Dreyer 2010)
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From page 281...
... 2003. Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial.
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Key Terms

  • implementation research
  • care delivery
  • observational studies
  • crt interventions
  • effectiveness research

  • cognitive impairment
  • brain injury
  • investigator involvement
  • health benefit
  • coverage policies

  • claims data
  • care patterns
  • data elements
  • traumatic brain
  • medical records

  • disease severity
  • tasks related
  • research stages
  • current care
  • specific domains

  • randomized trials
  • administrative claims
  • physical comorbidities
  • sufficient clinical
  • clinical interventions

  • facilitate behavioral
  • family caregivers
  • approaches require
  • tronic medical
  • inform subsequent


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