Application of the RE-AIM Framework for the Pediatric Mild Traumatic Brain Injury Evaluation and Management Intervention: A Study Protocol for Program Evaluation.

Paula W Tucker,David W Wright,Gerard A Gioia,Tim P Moran,Jonathan J Ratcliff,Harold K Simon,Rachel Bull,Usha Sathian,Shabnam Jain,Alex Hall

doi:10.3389/fpubh.2021.740238

Abstract

BackgroundChildren who experience a mild Traumatic Brain Injury (mTBI) may encounter cognitive and behavioral changes that often negatively impact school performance. Communication linkages between the various healthcare systems and school systems are rarely well-coordinated, placing children with an mTBI at risk for prolonged recovery, adverse impact on learning, and mTBI re-exposure. The objective of this study is to rigorously appraise the pediatric Mild Traumatic Brain Injury Evaluation and Management (TEaM) Intervention that was designed to enhance diagnosis and management of pediatric mTBI through enhanced patient discharge instructions and communication linkages between school and primary care providers.MethodsThis is a combined randomized and 2 × 2 quasi-experimental study design with educational and technology interventions occurring at the clinician level with patient and school outcomes as key endpoints. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be utilized as a mix methods approach to appraise a multi-disciplinary, multi-setting intervention with the intent of improving outcomes for children who have experienced mTBI.DiscussionUtilization of the RE-AIM framework complemented with qualitative inquiry is suitable for evaluating effectiveness of the TEaM Intervention with the aim of emphasizing priorities regarding pediatric mTBI. This program evaluation has the potential to support the knowledge needed to critically appraise the impact of mTBI recovery interventions across multiple settings, enabling uptake of the best-available evidence within clinical practice.

Highlights

Mild Traumatic Brain Injury is a considerable public health problem that is responsible for more than 70% of traumatic brain injuries in the United States [1, 2]
Children who sustain an Mild Traumatic Brain Injury (mTBI) may be seen in multiple healthcare settings across their recovery, such as primary care, urgent care, specialty clinics, Emergency Department (ED), and inpatient settings [5, 6], while most of the recovery phase occurs in the home and school settings [5]
The Traumatic Brain Injury Evaluation and Management (TEaM) study is a combined randomized and 2 × 2 quasi-experimental study design with training and technology interventions occurring at the provider level involving ED, urgent care (UC), primary care (PC) healthcare providers (HCPs) across the Children’s Healthcare of Atlanta system, with patient and school outcomes as key endpoints

Summary

Introduction

Mild Traumatic Brain Injury (mTBI) is a considerable public health problem that is responsible for more than 70% of traumatic brain injuries in the United States [1, 2]. Inconsistency in management approaches and treatment recommendations exist across the various healthcare settings [5, 7] Adding to this complexity is the reality that communication linkages between the healthcare systems and the schools are frail. As a result, this lack of communication and care coordination increases the risk of re-exposure to mTBI, less effective management in healthcare settings, and delayed recovery [5]. The objective of this study is to rigorously appraise the pediatric Mild Traumatic Brain Injury Evaluation and Management (TEaM) Intervention that was designed to enhance diagnosis and management of pediatric mTBI through enhanced patient discharge instructions and communication linkages between school and primary care providers

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Conclusion