Martin Laurie T, Farris Coreen, Parker Andrew M, Epley Caroline
Rand Health Q. 2013 Sep 1;3(3):4. eCollection 2013 Fall.
Improvised explosive devices have been used extensively against U.S. forces during Operation Enduring Freedom and Operation Iraqi Freedom and have been one of the leading causes of death. Injuries among survivors often include traumatic brain injuries (TBIs). Those recovering from TBIs often find they must coordinate services across multiple systems of care to meet all their medical and psychological health needs. This task is difficult even for those without the cognitive challenges associated with TBI and may prove overwhelming or even impossible, particularly during periods of transition from inpatient to outpatient services or from active duty to veteran status, for example. Although case management and care coordination are readily available for those who have experienced a severe TBI, fewer resources are available for those with symptomatic mild and moderate TBI. This article focuses on a program designed to facilitate care coordination for individuals with mild and moderate TBI, the Defense and Veterans Brain Injury Center Care Coordination Program. It summarizes RAND's assessment of the program's structure, activities, and implementation. To address the goals above, the authors conducted semistructured interviews in person with program administrators and via telephone with regional care coordinators. The subsequent analysis identified innovative practices, continuing challenges, and lessons learned. The recommendations provided here suggest strategies for meeting these challenges while maintaining the benefits possible through this novel approach to care.
简易爆炸装置在“持久自由行动”和“伊拉克自由行动”期间被广泛用于袭击美军，并且一直是主要的致死原因之一。幸存者的受伤情况通常包括创伤性脑损伤（TBI）。从创伤性脑损伤中恢复的人常常发现，他们必须在多个医疗系统之间协调服务，以满足所有的医疗和心理健康需求。即使对于那些没有与创伤性脑损伤相关的认知挑战的人来说，这项任务也很困难，而且可能证明是压倒性的，甚至是不可能完成的，例如，在从住院服务过渡到门诊服务或从现役军人过渡到退伍军人身份的期间。虽然对于经历过严重创伤性脑损伤的人来说，病例管理和护理协调服务很容易获得，但对于有症状的轻度和中度创伤性脑损伤患者来说，可用资源较少。本文重点介绍了一个旨在促进轻度和中度创伤性脑损伤患者护理协调的项目，即国防与退伍军人脑损伤中心护理协调项目。它总结了兰德公司对该项目的结构、活动和实施情况的评估。为了实现上述目标，作者亲自对项目管理人员进行了半结构化访谈，并通过电话与地区护理协调员进行了访谈。随后的分析确定了创新做法、持续存在的挑战以及吸取的经验教训。这里提供的建议提出了应对这些挑战的策略，同时保持通过这种新颖的护理方法可能获得的益处。
