Research and Advancements

Research and Advancements

Throughout the Polytrauma System of Care, we have established a comprehensive process for coordinating support efforts and providing information for each patient and family member. Specific progress in rehabilitation includes:

Enhanced DoD Collaboration

VA and DoD have shared a longstanding integrated collaboration in the area of TBI through the Defense and Veterans Brain Injury Center (DVBIC). Since 1992, DVBIC staff members have been integrated with VA Lead TBI Centers (now Polytrauma Rehabilitation Centers) to collect and coordinate surveillance of long-term treatment outcomes for patients with TBI. Other significant initiatives that have resulted from the ongoing collaboration between VA and DVBIC include: developing collaborative clinical research protocols; developing and implementing best clinical practices for TBI; developing materials for families and caregivers of Veterans with TBI; developing integrated education and training curriculum on TBI, and joint training of VA and DoD heath care providers; and coordinating the development of the best strategies and policies regarding TBI for implementation by VA and DoD.

Other DoD collaboration includes:

• Since 2007, VA has collaborated with DoD to develop plans for Defense Centers of Excellence (DCoE) and the associated injury registries (Centers for Psychological Health and Traumatic Brain Injury, Extremity Injuries and Amputation, Hearing Loss and Auditory System Injuries, and Vision).
• VA worked closely with DVBIC in the development of a uniform training curriculum for family members. "Traumatic Brain Injury: A Guide for Caregivers of Servicemembers and Veteran," which provides extensive information for caregivers through four detailed training modules.
• VA, DoD, and the National Center for Health Statistics have revised the International Classification of Diseases, Clinical Modification diagnostic codes for TBI, resulting in significant improvements in the identification, classification, tracking, and reporting of TBI and its associated symptoms.
• VA and DoD have developed clinical practice guidelines for mild TBI and deployed this to health care providers, as well as recommendations in the areas of cognitive rehabilitation, drivers' training, and managing the co-occurrence of TBI, post-traumatic stress disorder (PTSD), and pain.

Transitional Rehabilitation Program

In 2007, VA developed and implemented Transitional Rehabilitation Programs at each PRC. These 10-bed residential units provide rehabilitation in a home-like environment to facilitate community reintegration for Veterans and their families, focus on developing standardized program measures, and investigate opportunities to collaborate with other entities providing community-based reintegration services.

Emerging Consciousness Program

Beginning in 2007, VA implemented a specialized Emerging Consciousness care path at the four PRCs to serve those Veterans with severe TBI who are slow to recover consciousness. Patients with disorders of consciousness (e.g., comatose) require high complexity and intensity of medical services and resources in order to improve their level of responsiveness and decrease medical complications. To meet the challenges of caring for these individuals, VA collaboratively developed this care path with subject matter experts from DVBIC and the private sector. VA and DVBIC continue to collaborate on research in this area, and incorporate improvements to the care path in response to advances in science.

Traumatic Brain Injury Model Systems (TBIMS) Project

In 2008, the Department of Veterans Affairs (VA) established an interagency agreement with the Department of Education to include the VA Polytrauma Rehabilitation Centers (PRCs) in the ongoing Traumatic Brain Injury Model Systems of Care (TBIMS) project. This collaboration will enable the VA PRCs to track rehabilitation and functional outcomes of Veterans with TBI in a longitudinal design consistent with the existing 16 TBIMS centers tracking TBI in the private sector.

Telehealth Network

VA continues to optimize its Polytrauma Telehealth Network to facilitate provider-to-provider and provider-to-family coordination, as well as consultation from PRCs and Network Sites to other providers and facilities. Currently, about 30 to 40 videoconference calls are made monthly across the Network Sites to VA and DoD facilities. New Polytrauma Telehealth Network initiatives in development include home buddy systems to maintain contact with patients with mild TBI or amputation, and remote delivery of speech therapy services to Veterans in rural areas.

Reintegration Plan

VA developed and implemented a national template to ensure that it provides every Veteran receiving inpatient or outpatient treatment for TBI, who requires ongoing rehabilitation care, an individualized rehabilitation and community reintegration plan, as required by section 1702 of Public Law 110-181 (38 U.S.C. § 1710C). VA integrates this national template into the electronic medical record, and includes results of the comprehensive assessment, measurable goals, and recommendations for specific rehabilitative treatments. The patient and family participate in developing the treatment plan and receive a copy of the plan.