Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
Powers Pyles Sutter & Verville PC, 501 M Street, NW, Seventh Floor, Washington, DC 20005, United States of America.
Contemp Clin Trials. 2020 Apr;91:105970. doi: 10.1016/j.cct.2020.105970. Epub 2020 Feb 29.
Annually approximately 2-3 million Americans are so severely injured that they require inpatient hospitalization. The study team, which includes patients, clinical researchers, front-line provider and policy maker stakeholders, has been working together for over a decade to develop interventions that target improvements for US trauma care systems nationally. This pragmatic randomized trial compares a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists, versus trauma team notification of patient emotional distress with mental health consultation as enhanced usual care. The peer-integrated collaborative care intervention will be supported by a novel emergency department exchange health information technology platform. A total of 424 patients will be randomized to peer-integrated collaborative care (n = 212) and surgical team notification (n = 212) conditions. The study hypothesizes that patient's randomized to peer integrated collaborative care intervention will demonstrate significant reductions in emergency department health service utilization, severity of patient concerns, post traumatic stress disorder symptoms, and physical limitations when compared to surgical team notification. These four primary outcomes will be followed-up at 1- 3-, 6-, 9- and 12-months after injury for all patients. The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method will be used to assess implementation processes. Data from the primary outcome analysis and implementation process assessment will be used to inform an end-of-study policy summit with the American College of Surgeons Committee on Trauma. The policy summit will facilitate acute care practice changes related to patient-centered care transitions over the course of a single 5-year funding cycle. Trial registration: (Clinicaltrials.govNCT03569878).
每年约有 200 至 300 万美国人受重伤，需要住院治疗。该研究团队由患者、临床研究人员、一线医护人员和政策制定者利益相关者组成，他们已经合作了十多年，以制定针对美国创伤护理系统的干预措施，以改善该系统。这项实用随机试验比较了一种多学科团队协作护理干预措施，该措施将一线创伤中心工作人员与同行干预者整合在一起，与创伤团队通知患者的情绪困扰并提供心理健康咨询作为增强的常规护理。同行整合的协作护理干预措施将得到一种新的急诊部交换健康信息技术平台的支持。共有 424 名患者将被随机分配到同行整合的协作护理组（n=212）和手术团队通知组（n=212）。该研究假设，与手术团队通知相比，随机分配到同行整合的协作护理干预组的患者在急诊部的健康服务利用率、患者关注的严重程度、创伤后应激障碍症状和身体限制方面将显著降低。所有患者将在受伤后 1、3、6、9 和 12 个月对这四个主要结局进行随访。将使用快速评估程序知情临床民族志学（RAPICE）方法评估实施过程。主要结局分析和实施过程评估的数据将用于为美国外科医师学院创伤委员会的研究结束政策峰会提供信息。该政策峰会将促进与以患者为中心的护理过渡相关的急性护理实践变化，贯穿整个为期 5 年的单一资助周期。试验注册：（Clinicaltrials.govNCT03569878）。
