New coordinated care model for injured older adults shown to improve quality of life

New coordinated care model for injured older adults shown to improve quality of life

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Older adults who sustain serious injuries from falls or motor vehicle accidents often have impaired long-term functioning and a reduced quality of life, a new study suggests. published inside JAMA Surgery The study by the Regenstrief Institute and clinician researchers from the Indiana University and University of Wisconsin medical schools found that the new Trauma Medical Home Care model has a positive impact on elderly patients, especially those age 70 and older, who have a high burden of anxiety and depression after accidental 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 injured older adults, those who present with preexisting depression or anxiety following their injury, the care coordination and other resources provided by the Trauma Medical Home Care model improved both their psychological recovery and their quality of life,” said the study’s senior author, Malaz Boustani, MD, MPH, of the Regenstrief Institute and the Indiana University School of Medicine.

“In this study, we looked at those 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 older adults who are particularly vulnerable, perhaps those 70 or 75 and older; not just those with pre-injury psychological vulnerability, but also those with pre-injury frailty and social vulnerability.”

“The healthcare system in the United States is fragmented overall, especially for those who have a serious injury that requires hospitalization,” Dr. Boustani said.

“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 health outcomes of patients overall and the most vulnerable injury victims in particular.

“Collaborative care coordination can create a win-win situation that helps patients and the healthcare delivery system (including clinicians and health insurance companies) deliver healthcare the way it should be: better care for everyone.”

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.

Using assessments of post-injury cognitive, physical, behavioral and psychological disabilities and the special needs of trauma victims, the plan 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 and also manages and monitors recovery care plans.

“From my perspective as both a researcher and a critical care physician, the Trauma Medical Home can provide much-needed assistance to patients and their families as they cope with both the health effects of devastating and unexpected injuries and the multiple stressors during the long recovery process,” 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—all for the benefit of all.”

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.

More information:
Ben L. Zarzaur et al., Collaborative Care for Injured Older Adults, JAMA Surgery (2024). DOI: 10.1001/jamasurg.2024.1043

Provided by Regenstrief Institute

Quotation: New coordinated care model for injured older adults shown to improve quality of life (2024, July 10) Retrieved July 10, 2024 from

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