Traumatic Brain Injury A Roadmap for Accelerating Progress (2022) / Chapter Skim
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Pages 1-14
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A 10-year National Research Action Plan for TBI and posttraumatic stress disorder was established in 2012 by executive order among key agencies involved in TBI research. Large translational research initiatives have been undertaken to learn about the pathophysiology of brain injury, patient trajectories, and interventions to support recovery.
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TBIs are associated with adverse mental health out comes including posttraumatic stress disorder (PTSD) , anxiety, depression, and suicidality.
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3. Reduce unwarranted variability and gaps in administrative and clinical care guidance to ensure high-quality care for TBI.
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Conclusion: TBI care in the United States often fails to meet the needs of individu als, families, and communities affected by this condition. TBI is an ongoing condi tion that poses significant burdens over time, including substantial financial and social costs.
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a. Relevant professional societies should encourage clinicians to recommend that all patients at discharge from inpatient and outpatient acute care settings have an oppor tunity for follow-up with a clinician experienced in managing TBI.
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Ensure Quality and Consistency of Care Unwarranted variability and gaps in care guidance need to be addressed, and guidelines and best practices need to be consistently implemented, including to guide reimbursement practices. The evidence to inform TBI care decisions should be based on a range of rigorous methodologies for generating knowledge and include evidence obtained not only from randomized controlled trials but also from observational cohort and other study designs and from expert consensus on best practices.
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Organizations working closely with these groups should be involved in efforts to develop and disseminate practical information on TBI. Given the prevalence and burden of TBI, multiple health care professionals, including physicians, nurses, emergency medical technicians, psychologists, and rehabilitation professionals, need sufficient training in and guidance on
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Individual patients would benefit if clinicians and health care organizations had the capacity and commitment to view the TBI care they provide -- and the system's duties -- through the lens of the bio-psycho-socio-ecological model, and to do so not just once but continuously and repeatedly through each patient's life journey, adjusting treatments, assessments, and community resources as the patient's status and needs change. Doing so would require a level of continuity and acceptance of responsibility that American health care does not often achieve for chronic illnesses.
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The Centers for Disease Control and Prevention should expand efforts to track TBI mortality, morbidity, and long-term outcomes more completely and accurately, including by adding validated, standardized TBI ques tions to population-based and weighted surveys and working to ensure consistency of information across states and surveys. The Agency for Healthcare Research and Quality should modify and expand the Healthcare Cost and Utilization Project to enable improved analysis of TBI care patterns, costs, and outcomes, both acute and long-term.
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National Trauma Databank and Trauma Quality Improvement Program; state trauma registries; the National Institute on Disability, Independent Living, and Rehabilitation Research's (NIDILRR's) TBI Model Systems database; the DoD Trauma Registry; and VA TBI registries.
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G. Innovate and disseminate improved designs for coordinated TBI care in organizations and regions, with special attention to patients' and families' long-term needs and follow-up. H. Expand TBI research in areas with a weak history of TBI focus, including health care quality, health economics, and implementation science research.
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To this end, the Secretary of HHS should establish, for a period of 10 years, a national Traumatic Brain Injury Task Force as a successor to the National Research Action Plan. The TBI Task Force should move beyond an emphasis solely on research coordination to encompass a focus on research implementation and application of the evidence in support of better treatment and systems of care delivery, engaging an expanded group of federal, private-sector, and philanthropic partners.
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But bringing the best achievable outcomes to persons with TBI and their families will require a wholesale redesign of TBI systems to reflect the timing and many manifestations of the condition, and to guarantee linked and coordinated care across time and sites of care to deliver what matters most to patients and their loved ones.
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