Evaluation of a new Transmural Trauma Care Model (TTCM) for the rehabilitation of trauma patients: a study protocol

Suzanne H Wiertsema,Maaike Schothorst,Raymond W J G Ostelo,Vincent De Groot,Frank W Bloemers,Johanna M Van Dongen,Edwin Geleijn

doi:10.1186/s12913-017-2037-2

Abstract

BackgroundImproved organization of trauma care in the acute phase has reduced mortality of trauma patients. However, there has been limited attention for the optimal organization of post-clinical rehabilitation of trauma patients. Therefore we developed a Transmural Trauma Care Model (TTCM). This TTCM consists of four equally important components: 1) intake and follow up consultations by a multidisciplinary team consisting of trauma surgeon and hospital based trauma physical therapist, 2) coordination and individual goal setting for each patient by this team, 3) primary care physical therapy by specialized physical therapists organized in a network and 4) E-health support for transmural communication and treatment according to protocols. The aim of the current study is to assess the cost-effectiveness of the TTCM.MethodsPatients will be recruited from the outpatient clinic for trauma patients of the VU University Medical Center (VUmc) if they have at least one fracture and were discharged home. A controlled-before-and-after study design will be used to compare the TTCM with regular care. Measurements will take place after the first outpatient clinical visit and after 3, 6 and 9 months. Prior to the implementation of the TTCM, 200 patients (50 patients per time point) will be included in the control group. After implementation 100 patients will be included in the intervention group and prospectively followed. Between-group comparisons will be made separately for each time point. In addition, the recovery pattern of patients in the intervention group will be studied using longitudinal data analysis methods. Effectiveness will be evaluated in terms of health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Cost-effectiveness will be assessed from a societal perspective, meaning that all costs related to the TTCM will be taken into account including intervention, health care, absenteeism, presenteeism and unpaid productivity. Additionally, a process evaluation will be performed to explore the extent to which the TTCM was implemented as intended, and to identify possible facilitators and barriers associated with its implementation.DiscussionThis planned research will give insight into the feasibility of the TTCM model in clinical practice and will give a first indication of the cost-effectiveness of the TTCM and help us to further develop post-clinical trauma care.Trial registrationTrial registration number: NTR5474. The Netherlands National Trial Register (NTR). Registered 12 October 2015.

Highlights

Improved organization of trauma care in the acute phase has reduced mortality of trauma patients
Little is currently known about how to optimally organize the post-clinical rehabilitation process for trauma patients transferred from hospital to primary care
The Transmural trauma care model (TTCM) for the post-clinical rehabilitation of trauma patients was developed at the VU University Medical Center (VUmc), which aims to improve health-related quality of life (HR-QOL), functional outcome and patient satisfaction of trauma patients, by organizing the postclinical rehabilitation in an innovative and more efficient way

Summary

Introduction

Improved organization of trauma care in the acute phase has reduced mortality of trauma patients. There has been limited attention for the optimal organization of post-clinical rehabilitation of trauma patients. Due to the major impact of trauma on mortality, morbidity, and (societal) costs, there has been increased interest in the organization of trauma care over the last three decades. During the last two decades, an improved organization of pre-hospital and in-hospital care by developing specialized trauma centers using Advanced Trauma Life Support (ATLS®) guidelines, has led to a 15–25% decrease in mortality of severe trauma patients [8,9,10,11]. There is limited attention for optimizing the organization of the post-clinical physical rehabilitation of trauma patients in primary care, which may have led to an inefficient and/or suboptimal rehabilitation process. In contrast to secondary and tertiary care, guidelines and protocols, as well as an interdisciplinary coordination, are lacking in primary care

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