A Policy Relevant US Trauma Care System Pragmatic Trial for PTSD and Comorbidity

The overarching goal of this UH2-UH3 proposal is to work with the NIH Health Care Systems
Research Collaboratory to develop and implement a large scale, cluster randomized pragmatic
clinical trial demonstration project that directly informs national trauma care system
policy targeting injured patients with presentations of Posttraumatic Stress Disorder (PTSD)
and related comorbidity. Each year in the United States (US), over 30 million individuals
present to trauma centers, emergency departments, and other acute care medical settings for
the treatment of physical injuries. Multiple chronic conditions including enduring PTSD,
alcohol and drug use problems, depression and associated suicidal ideation, pain and somatic
symptom amplification, and chronic medical conditions (e.g., hypertension, coronary artery
disease, diabetes, and pulmonary diseases) are endemic among physical trauma survivors with
and without traumatic brain injuries (TBI). Evidence-based, collaborative care/care
management treatment models for PTSD and related comorbidities exist. These care management
models have the potential to be flexibly implemented in order to prevent the development of
chronic PTSD and depressive symptoms, alcohol use problems, and enduring physical disability
in survivors of both TBI and non-TBI injuries; care management models may also be effective
in mitigating the impact of the acute injury event on symptom exacerbations in the large
subpopulation of injury survivors who already carry a substantial pre-injury burden of
multiple chronic medical conditions.