Duchnick Jennifer J, Ropacki Susan, Yutsis Maya, Petska Kelly, Pawlowski Carey
Mental Health and Behavioral Sciences Service, James A. Haley Veterans Affairs Medical Center.
Polytrauma System of Care, Polytrauma Transitional Rehabilitation Program, VA Palo Alto Health Care System.
Psychol Serv. 2015 Aug;12(3):313-21. doi: 10.1037/ser0000034. Epub 2015 May 4.
When the U.S. Congress passed the Veterans Health Programs Improvement Act of 2004 and the Consolidated Appropriations Act in 2005, Veterans Affairs (VA) traumatic brain injury centers responded by establishing and developing the polytrauma rehabilitation centers and polytrauma transitional rehabilitation programs (PTRPs) across 4 sites in Minneapolis, Minnesota, Palo Alto, California, Richmond, Virginia, and Tampa, Florida, in 2007. The 5th PTRP was opened in 2011 in San Antonio, Texas. This article presents the context of establishing these programs within a VA system, describes aspects of programmatic design, and shares characteristics and outcomes of individuals served by the first 4 national centers. PTRPs provide specialized, interdisciplinary brain injury rehabilitation to active-duty service members and veterans with complex rehabilitation needs. A total of 286 individuals participated in the first 4 PTRPs during the first 3 years. Admission and discharge data were collected as part of routine care, and data review focused on describing the demographic, injury, and neurobehavioral functioning outcomes across 4 sites. Mayo-Portland Adaptability Inventory Abilities, Adjustment, and Participation subscales and total scale T-scores served as primary functioning outcome measures. Mean scores are presented. Statistical analysis found a significant change in total scale T-score from admission to discharge, consistent with improved patient functional ability. Challenges associated with the development and implementation of programs are discussed. Elements of programming may be applicable for other health care organizations that seek to improve rehabilitation care delivery.
2004年美国国会通过了《2004年退伍军人健康项目改进法案》，2005年又通过了《综合拨款法案》，退伍军人事务部（VA）的创伤性脑损伤中心做出回应，于2007年在明尼阿波利斯、明尼苏达州、帕洛阿尔托、加利福尼亚州、里士满、弗吉尼亚州和坦帕、佛罗里达州的4个地点建立并发展了多创伤康复中心和多创伤过渡康复项目（PTRPs）。第五个PTRP于2011年在得克萨斯州圣安东尼奥市开业。本文介绍了在VA系统内建立这些项目的背景，描述了项目设计的各个方面，并分享了前4个国家中心所服务个体的特征和结果。PTRPs为有复杂康复需求的现役军人和退伍军人提供专门的、跨学科的脑损伤康复服务。在最初的3年里，共有286人参与了前4个PTRPs项目。作为常规护理的一部分，收集了入院和出院数据，数据审查的重点是描述4个地点的人口统计学、损伤和神经行为功能结果。梅奥-波特兰适应性量表的能力、调整和参与子量表以及总量表T分数作为主要的功能结果指标。给出了平均分数。统计分析发现，从入院到出院，总量表T分数有显著变化，这与患者功能能力的改善一致。文中讨论了与项目开发和实施相关的挑战。项目的要素可能适用于其他寻求改善康复护理服务的医疗保健组织。
