A Comparative Effectiveness Trial of Optimal Patient-Centered Care

The nation's trauma care system, which includes trauma center hospitals & emergency
departments, is where over 30 million Americans receive care after traumatic injuries each
year. Injury victims are diverse patients who suffer from complications of the initial injury
as well as from multiple complex medical & mental health conditions. Currently, high-quality
patient-centered care is not the standard of care throughout US trauma care systems. Injured
trauma survivors treated in trauma care systems frequently receive fragmented care that is
not coordinated across hospital, emergency department, outpatient, & community settings.
Post-injury care is frequently not individualized to integrate the patient's most pressing
post-traumatic concerns & preferences into medical decision making. The investigators, as a
group of front-line trauma center providers, patients, researchers & policy makers, have been
working together for over a decade to integrate patient-centered care into US trauma care
systems. The investigators began this work by asking groups of injured patients the key
patient-centered question: "Of everything that has happened to you since your injury, what
concerns you the most?" The investigators developed scientifically sound assessment tools
that allowed us to follow patient concerns after injury hospitalization. In May of 2011, the
investigators convened an American College of Surgeons' policy summit that addressed mental
health & patient-centered care integration across US trauma care systems. As part of this
policy summit, patient members of our team presented their experiences of traumatic injury &
recovery. While giving injured patients a "voice" at the summit, these narratives did not
move surgical policy makers to develop mandates or guidelines for patient-centered care. In
contrast, presentations that included information from randomized comparative effectiveness
trials & standardized outcome assessments convinced surgical policy makers to develop US
trauma care system policy mandates & best practice guidelines for post-traumatic stress
disorder & alcohol use problems. Our team now realizes that in order to optimally integrate
patient-centered care into US trauma care systems, the investigators must use the best
scientific methods that capture the highest-quality data. This PCORI proposal aims to
demonstrate that a patient-centered care management treatment that addresses patient's
post-injury concerns & integrates patient concerns & preferences into medical decision
making, while also coordinating care, can improve outcomes of great importance to patients &
their caregivers, front-line providers & policy makers. This proposal directly addresses two
PCORI patient-centered research questions: "After a traumatic injury, what can I do to
improve the outcomes that are most important to me?" & "How can front-line providers working
in trauma care systems help me make the best decisions about my post-injury health & health
care?"