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New Care Model for Injured Elderly Announced

New Care Model for Injured Elderly Announced

INDIANAPOLIS – Many older adults who sustain serious injuries from falls or motor vehicle accidents experience long-term functional impairment and a decreased quality of life. A new study published in JAMA Surgery by the Regenstrief Institute and researcher-clinicians from the Indiana University and University of Wisconsin Schools of Medicine found that the new Trauma Medical Home model of care has a positive impact on older patients, especially those age 70 and older, who have accident-related injuries and resulting surgeries.

The new Trauma Medical Home coordinated care model developed by the study authors provides much-needed support and resources to injury survivors after hospital discharge, with the goals of improving and accelerating recovery from physical or psychological injuries for a better quality of life. To achieve these goals, the care model aims to eliminate barriers that impede patient-centered recovery, including poor adherence to medications and therapies after hospital discharge, fragmented care, and inadequate attention to the medical, psychological, and cognitive aspects of trauma recovery.

“We found that for a particularly vulnerable segment of older injury victims — those who come to their injuries with preexisting depression or anxiety — the care coordination and other resources provided by the Trauma Medical Home model of care improved both their psychological recovery and their quality of life,” says the study’s senior author, Malaz Boustani, MD, MPH, of the Regenstrief Institute and Indiana University School of Medicine. “In this study, we looked at people age 50 and older, and we found benefit for the oldest patients in our clinical trial. The next iteration of Trauma Medical Home will focus on these particularly vulnerable older adults, perhaps age 70 or 75 and older — not only those with pre-injury psychological vulnerability, but also those with pre-injury frailty and social vulnerability.

“The U.S. healthcare system is fragmented overall, especially for those who sustain a serious injury requiring hospitalization,” Dr. Boustani observed. “In the current healthcare transformation from volume-based to value-based care, the fragmented nature of acute injury recovery after hospital discharge will impact the quality of care and overall health outcomes of patients, especially the most vulnerable injury victims. Collaborative care coordination can create a win-win situation that helps patients and the healthcare delivery system (including clinicians and health insurance companies) deliver what healthcare is meant to be—better care for everyone—now.”

The key component of the Trauma Medical Home is the care coordinator, a specially trained nurse who is supported by an interdisciplinary team of clinicians including a geriatrician, surgeon, pulmonologist/critical care physician, and neuropsychologist, and provides advice and support upon request. Together with the care coordinator and in consultation with the patient and their caregivers, the team designs an individualized recovery plan.

The plan — using assessments of post-injury cognitive, physical, behavioral and psychological disabilities and special needs of trauma victims — may include monitoring hospital discharge orders, liaison with community-based service providers and organizations, medication adherence and appropriateness of medications, as well as general care instructions. The care coordinator conducts patient visits and analyzes preventable rehospitalizations, as well as manages and monitors recovery care plans.

“From my perspective as both a researcher and a critical care physician, Trauma Medical Home can provide much-needed assistance to patients and their families as they manage both the health impacts of devastating and unexpected injuries and the many stressors during the long recovery period,” said study co-author Babar Khan, MD, researcher-clinician at the Regenstrief Institute and IU School of Medicine. “This model of care can also help accountable care organizations and insurers save or even make money by accelerating the delivery of quality care, optimizing patient recovery and ultimately improving health outcomes — benefiting everyone.”

The study enrolled 429 men and women (age 50 years or older, hip fracture from a fall, serious injury from a motor vehicle accident, or other traumatic injury requiring surgery) without cognitive impairment. They were discharged from one of three Level I trauma centers in Indianapolis or one in Madison, Wisconsin, and were randomly assigned to usual care or the Trauma Medical Home intervention.

The Trauma Medical Home is an adaptation for older adults with traumatic injuries of collaborative care models developed by the Regenstrief Institute and IU School of Medicine researchers-clinicians that have previously demonstrated success in high-need medical populations, including the Geriatric Resources for Assessment and Care of the Elderly (GRACE) model and the Improving Mood: Promoting Access to Collaborative Care (IMPACT) model.

The primary measure of recovery or deterioration of patients in both the Trauma Medical Home and usual care arms of the new study was the Healthy Aging Brain Care Monitor, a 32-item questionnaire developed by Dr. Boustani and colleagues that measures cognitive, physical, and psychological symptoms. Each question on the Healthy Aging Brain Care Monitor indicates a specific area where help or coping strategies are indicated. Patients’ scores triggered adjustments to their Trauma Medical Home care protocols.

Depression and anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder scale-7 (GAD-7), widely used mental health screening tools co-developed by Regenstrief Institute Research Scientist Dr. Kurt Kroenke.

The developers of the Trauma Medical Home say the model has real potential to positively impact care delivery, accelerate and enhance recovery, and improve health outcomes.

Collaborative Care for Injured Older Adults: The Trauma Medical Home Randomized Clinical TrialPublished in JAMA Surgery. The work was supported by National Institute on Aging award R01AG076489 of the National Institutes of Health (PI: B. Zarzaur and M. Boustani).

Authors and Links:

I am L. Zarzaurone, Emma Holler2, Damaris Ortiz3, Anthony Perkins4, Sue Laister5, Sujuan Gao4, Dustin D. French6, Babar Khan7, Malaz Boustani7.8

oneDepartment of Surgery, Division of Acute Care and Regional General Surgery, University of Wisconsin School of Medicine and Public Health, Madison.

2Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington.

3Department of Surgery, Indiana University School of Medicine, Indianapolis.

4Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis.

5School of Nursing and Health Studies, Health Sciences Area, University of Missouri, Kansas City.

6Department of Ophthalmology and Medical Social Sciences, Northwestern University, Chicago, Illinois.

7Department of Medicine, Indiana University School of Medicine, Indianapolis.

8Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis.

Malaz Boustani, MD, MPH

In addition to his role as a research scientist at the Indiana University Center for Aging Research in the Regenstrief Institute, Malaz Boustani, MD, MPH, is the founding director of the Center for Health Innovation and Implementation Science. He is the Richard M. Fairbanks Professor of Aging Research at the Indiana University School of Medicine – Indianapolis. Dr. Boustani is also director of care innovation at Eskenazi Health.

Babar Khan, MD, MS

In addition to his role as associate director and research scientist at the Indiana University Center for Aging Research in the Regenstrief Institute, Dr. Khan is also a professor of medicine and the Floyd and Reba Smith Professor of Respiratory Diseases in the Division of Lung Diseases at the Indiana University School of Medicine – Indianapolis. In January 2024, he was appointed the first chief of the newly created Division of Critical Care Medicine – Indiana Critical Care Management and Recovery Program in the IU Division of Pulmonary, Critical Care, Sleep and Occupational Health.

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