JMIR Publications

ABSTRACT

People with traumatic brain injury (TBI)-related morbidity (impaired cognition, behavioral regulation) and polytrauma comorbidity (depression, posttraumatic stress disorder (PTSD), chronic pain, sleep disorders) experience healthcare inequities leading to poor health outcomes. Our work has highlighted that Veterans and Service Members (V/SMs) with TBI have high rates of rehospitalization, unique healthcare needs, and distinct causes of early mortality (self-inflicted deaths and preventable injuries). Any TBI morbidity or polytrauma comorbidity may impact access and meaningful engagement in the high-quality healthcare needed to reduce poor healthcare outcomes. The National Academy of Science, Engineering, and Medicine Report on Accelerating Progress in TBI recognizes and calls for action to improve healthcare access for persons with TBI and highlights a dearth of implementation science research in TBI that may help overcome healthcare access challenges. Implementation science uses a mixed methods approach to understand, implement, and examine outcomes associated with using evidence-based care in practice. It also uses evidence-based practice for adaptations or innovations in how care is delivered (to retain technical quality, fidelity) across healthcare systems (e.g., Veterans Affairs, Department Of Defense, civilian settings) and populations (e.g., disabled vs healthy cohorts) to achieve healthcare equity. The I-HEAL protocol includes four synergistic projects with the goal to address key knowledge gaps that will improve access and engagement in high-quality, evidence-based healthcare services for V/SM with TBI morbidity. Specific foci include the following: Project 1) development of a nudge intervention (electronic healthcare reminder) for providers to engage healthcare proxies when interacting with cognitive disability at risk for poor healthcare engagement; Project 2) development of a provider toolkit of adaptations of guideline-endorsed behavioral health interventions for common polytrauma comorbidities (sleep, PTSD, depression, chronic pain) to meet the needs of cognitively impaired individuals; Project 3) adaptation and dissemination of evidence-based team interventions for managing maladaptive behaviors after TBI; and Project 4) evaluation and recommendations for policy for virtual health modalities for persons with TBI and polytrauma comorbidity. Collectively the four projects propose to accomplish the following overarching objectives: 1) adapt existing interventions to promote access and engagement in healthcare; 2) engage stakeholder communities to maximize uptake and translation; 3) promote research translation that informs policy and practice through knowledge translation products and deliverables targeting key partners (clinicians, Veterans, Service Members, caregivers, policymakers, and other researchers); 4) facilitate research and implementation to enhance access to high-quality healthcare for V/SM with TBI-related morbidity; and 5) foster development of early/mid-career researchers in advancing implementation science research on access to care for V/SM with TBI. TBI is associated with increased healthcare utilization, comorbid health conditions, and premature mortality. This study proposed to utilize strategies from the implementation science field to help overcome barriers to physical and psychological healthcare to reduce healthcare disparities associated with TBI disability.