创伤后幸存者中心：满足创伤后中心护理的巨大未满足需求。
The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care.
机构信息
From the Division of Trauma and Surgical Critical Care (D.H.L., P.Y., A.C.M.), Department of Physical Medicine and Rehabilitation (P.Y.), Rutgers New Jersey Medical School; Rutgers University Behavioral Health Center (C.C.); and the Eric Munoz Trauma Center (S.L.B., D.S., C.C., P.A.W.), University Hospital, Newark, New Jersey.
出版信息
J Trauma Acute Care Surg. 2020 Nov;89(5):940-946. doi: 10.1097/TA.0000000000002775.
BACKGROUND
Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions.
METHODS
Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC.
RESULTS
Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship "no show" rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS.
CONCLUSION
A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC.
LEVEL OF EVIDENCE
Therapeutic, Level III.
背景
使患者恢复到受伤前的状态是创伤系统的目标。创伤中心（TC）提供住院治疗，但出院后的治疗是碎片化的，门诊随访率<30%。创伤后应激障碍（PTSD）和抑郁症很常见，但很少有患者获得必要的行为健康服务。我们推测，一个提供全面护理的多学科创伤幸存者中心（CTS）将满足患者的需求，提高出院后的依从性，提供行为健康服务，并减少计划外急诊部（ED）就诊和再入院。
方法
对创伤幸存者进行焦点小组讨论，以确定 TC 出院后的问题。创伤幸存者中心（CTS）的合格患者年龄在 18 至 80 岁之间，重症监护病房（ICU）入住时间>2 天，或新损伤严重程度评分（New Injury Severity Score）≥16。创伤幸存者中心（CTS）的就诊由专门的导航员安排，包括身体和行为健康护理。对患者进行 PTSD 和抑郁筛查。筛查阳性的患者被转介接受行为健康服务。患者可以 24/7 获得 CTS 团队的支持。出院后一年内的结局包括预约、心理健康就诊、计划外 ED 就诊和再入院的依从性。
结果
患者普遍感到出院后被 TC 抛弃。在过去的一年中，有 107 名患者进行了 386 次 CTS 就诊。每次预约的平均时间>1 小时。CTS“失约”率为 17%。86%的 PTSD/抑郁筛查阳性患者成功获得了行为健康服务。出院后 ED 和医院就诊主要是感染或无关疾病。ED 就诊率明显低于 CTS 成立前一年同期受伤程度相似的患者组。
结论
创伤幸存者中心（CTS）填补了 TC 出院后护理的巨大空白，提高了预约和身体及行为健康服务的提供的依从性。创伤幸存者中心（CTS）似乎也降低了出院后一年内的 ED 就诊率。为了实现从受伤中获得最佳的长期康复，创伤护理必须在患者离开 TC 后持续很长时间。
证据水平
治疗性，III 级。
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