Researchers will evaluate traumatic brain injury treatment at both OHSU and Legacy Health System's four hospitals, rehabilitation and outpatient services. Legacy serves as the study's model system; it provides and coordinates treatment from the emergency department, through acute care, inpatient and outpatient rehabilitation, re-entry into the community and vocational rehabilitation. Researchers will compare outcomes for consenting patients who pass through the Legacy system with outcomes for OHSU patients. "Traumatic brain injury patients recover over a long period in the care of many different people," said Anthony Borzotta, M.D., associate trauma director at Legacy Emanuel Hospital. "Only by having a consistent, long-term database on these patients can we know which approaches work best. This grant will allow us to start building that database."
The Oregon study is part of the national Traumatic Brain Injury Model Systems program, which has been in existence since 1987. There are currently approximately 1000 patients in the database with follow-up data for eight years, according to Mitchell Rosenthal, Ph.D., project director of the Traumatic Brain Injury National Database Management Center at Wayne State University in Detroit. "The type of data collected enables researchers to better understand what types of long-term outcome can be expected, given initial medical complications and severity of brain injury, as well as the length of stay, costs and benefits of a coordinated system of care," said Rosenthal.
This research is part of a national push to better track what happens to brain injury patients once they leave the hospital. "Unfortunately, brain injury patients may have a remarkable recovery in the hospital, only to face extreme difficulty once they re-enter the community," said Hugo Maynard, Ph.D., emeritus professor of psychology at Portland State University and another of the principal investigators on the project. "Without proper attention, these patients can fall into poverty and mental illness. Armed with data from this study, hopefully we can prevent many of those patients from falling through the cracks." An important aid to follow-up of discharged survivors will be the collaboration with the Brain Injury Support Group of Portland, which will contribute its extensive network of contacts to the research effort.
The study will focus not only on patients who stay within the OHSU and Legacy systems, but those who return to their homes in rural areas after discharge. Patients from rural areas may not have access to rehabilitation services and may not have the time or resources to travel hundreds of miles to a larger community for treatment.
Starting in October of this year, traumatic brain injury patients or their families will be asked for their consent to participate in the study. Student volunteers from Portland State University's Community Psychology program will collect data on OHSU patients. Legacy Health System's Research Department staff will collect data on that system's patients. A questionnaire developed by Chesnut and Borzotta will help measure the severity of illness and the intensity of nursing care needed for each patient. The contribution of nurses who care for study patients is critical to the study.
The grant period is four years. The research team expects to have preliminary results in about a year, and a full set of data in roughly five years.
Additional investigators for the grant project are Nancy A. Carney, Ph.D., M.S., and N. Clay Mann, Ph.D., M.S., both of the Department of Emergency Medicine at OHSU; Mckay M. Sohlberg, Ph.D., of the College of Education at the University of Oregon; and Anne E. Glang, Ph.D., and Bonnie J. Todis, Ph.D., both of Teaching Research, a program of the Oregon University System.
Other contributors include Danielle J. Erb, M.D., of Rehabilitation Medical Associates in Portland; Aimee Mooney, M.S., and Jo Tanzer, M.S, both of Legacy Rehabilitation Services in Portland; and Barbara Krauss, R.N., and associates at Legacy Holladay Park Medical Center in Portland; and Sandra Faulkner, R.N., C.C.R.N.C., and Judy Austin, C.R.C., at Legacy Health System's Research Services in Portland.