Joel Scholten1, Ellen Danford, Azadeh Leland, Heather Malecki, Douglas Bidelspach, Brent Taylor, Nina Sayer. 1. Joel Scholten, MD, is Associate Chief of Staff for Rehab Services at the Washington DC VA Medical Center and National Director of the VA's Physical Medicine & Rehabilitation Program Office. He is Assistant Clinical Professor of Rehabilitation Medicine at Georgetown University School of Medicine and serves as Director of the DC VA's Advanced Polytrauma Fellowship program. Ellen Danford, BA, is Health Science Specialist and Research Coordinator at the Washington DC VA Medical Center. During her time at the VA, Ms. Danford has been highly involved in quality improvement projects and randomized controlled trials. Azadeh Leland, DScPT, is a graduate of University of Maryland post-professional doctor of science in physical therapy and rehabilitation services. She has also completed a 2-year fellowship in Polytrauma and Rehabilitation services at the VA. Dr. Leland has 25 years of clinical experience as a physical therapist. Heather Malecki, DPT, is Polytrauma and Rehabilitation Coordinator for Physical Medicine & Rehabilitation at the Washington, DC VA Medical Center. She coordinates the VISN 5 Polytrauma Network Site and Polytrauma Support Clinic Teams. She serves as PT/TBI Fellowship Clinical Director for the Washington DC VA and on the VA National Physical Therapy Federal Advisory Board. Douglas Bidelspach, MPT, currently serves as Rehabilitation Planning Specialist for Rehabilitation and Prosthetic Services in VA Central Office where he is responsible for database development, utilization, and management in support of planning and administration of VA rehabilitation and health care programs. Brent Taylor, PhD, MPH, is Associate Director at the Minneapolis VA Health Care System's Center for Chronic Disease Outcomes Research. He is Associate Professor of Medicine and Adjunct Associate Professor of Epidemiology and Community Health at the University of Minnesota. Nina A. Sayer, PhD, LP, is Deputy Director of the Center of Innovation (COIN) at the Minneapolis VA Healthcare System, the Center for Chronic Disease Outcomes Research (CCDOR). She is also Associate Professor in the Departments of Medicine and Psychiatry and Adjunct Associate Professor in the Department of Psychology at the University of Minnesota. Her funded research has examined posttraumatic stress disorders, psychiatric disability, unmet needs for mental health treatment, and traumatic brain injury/polytrauma.
Abstract
PURPOSE OF STUDY: Individualized interdisciplinary care is the hallmark for rehabilitation following traumatic brain injury (TBI). Veterans Health Administration (VHA) utilizes an electronic note template to document Interdisciplinary Rehabilitation and Community Reintegration (IRCR) care plans for Veterans with TBI requiring rehabilitation. All Veterans with a TBI diagnosis, receiving skilled therapy for TBI-related issues, and followed by a case manager must receive a care plan. The purpose of this study was to determine the level of compliance with the IRCR care plan requirements used to identify Veterans with TBI in need of the care plan and to evaluate the reasons for inconsistent compliance. In addition, the study sought to provide a more objective assessment of Veterans with TBI requiring an IRCR to assist in establishing a target metric. PRIMARY PRACTICE SETTING: TBI outpatient clinics. METHODOLOGY AND SAMPLE: Investigators conducted a retrospective medical record review of 546 Veterans with a TBI diagnosis seen at the Washington, DC VA Medical Center's outpatient polytrauma clinics in 2013. Cases were initially reviewed for referral or engagement with skilled therapy. Charts where Veterans were referred or engaged with skilled therapy were forwarded to 2 polytrauma clinicians to determine whether therapy was requested to treat a TBI-related condition. Finally, charts were reviewed for case management and analyzed for algorithm compliance. Analysis focused first on compliance with IRCR algorithm requirements and secondarily with identifying potential reasons for noncompliance. RESULTS: In 2013, 42% of the TBI cohort met the criteria for an IRCR. The vast majority of cases with a TBI diagnosis complied with IRCR algorithm criteria; however, 14% of all reviewed cases required an IRCR but did not receive one. Provision of case management outside of the TBI/polytrauma clinic characterized a majority of noncompliant cases. IMPLICATIONS FOR CASE MANAGEMENT: Interdisciplinary care can be challenging, particularly in the outpatient setting, due to patient availability and access to care. Improved documentation in the electronic health record may assist case managers and other clinicians in coordinating rehabilitation care for Veterans with TBI. Case managers in the VA and other settings may find templates and trackable health factors helpful to identify patients in need of care plans.
PURPOSE OF STUDY: Individualized interdisciplinary care is the hallmark for rehabilitation following traumatic brain injury (TBI). Veterans Health Administration (VHA) utilizes an electronic note template to document Interdisciplinary Rehabilitation and Community Reintegration (IRCR) care plans for Veterans with TBI requiring rehabilitation. All Veterans with a TBI diagnosis, receiving skilled therapy for TBI-related issues, and followed by a case manager must receive a care plan. The purpose of this study was to determine the level of compliance with the IRCR care plan requirements used to identify Veterans with TBI in need of the care plan and to evaluate the reasons for inconsistent compliance. In addition, the study sought to provide a more objective assessment of Veterans with TBI requiring an IRCR to assist in establishing a target metric. PRIMARY PRACTICE SETTING: TBI outpatient clinics. METHODOLOGY AND SAMPLE: Investigators conducted a retrospective medical record review of 546 Veterans with a TBI diagnosis seen at the Washington, DC VA Medical Center's outpatient polytrauma clinics in 2013. Cases were initially reviewed for referral or engagement with skilled therapy. Charts where Veterans were referred or engaged with skilled therapy were forwarded to 2 polytrauma clinicians to determine whether therapy was requested to treat a TBI-related condition. Finally, charts were reviewed for case management and analyzed for algorithm compliance. Analysis focused first on compliance with IRCR algorithm requirements and secondarily with identifying potential reasons for noncompliance. RESULTS: In 2013, 42% of the TBI cohort met the criteria for an IRCR. The vast majority of cases with a TBI diagnosis complied with IRCR algorithm criteria; however, 14% of all reviewed cases required an IRCR but did not receive one. Provision of case management outside of the TBI/polytrauma clinic characterized a majority of noncompliant cases. IMPLICATIONS FOR CASE MANAGEMENT: Interdisciplinary care can be challenging, particularly in the outpatient setting, due to patient availability and access to care. Improved documentation in the electronic health record may assist case managers and other clinicians in coordinating rehabilitation care for Veterans with TBI. Case managers in the VA and other settings may find templates and trackable health factors helpful to identify patients in need of care plans.
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