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Polytrauma and Blast-Related Injuries (PT/BRI) QUERI
Overview
The mission of the Polytrauma and Blast-Related Injuries (PT/BRI) QUERI is to promote the successful rehabilitation, psychological adjustment and community re-integration of individuals who have sustained polytrauma (PT) and blast-related injuries.
The scope of the PT/BRI QUERI includes the full range of health problems, health care system and psychosocial factors represented in this mission. However, PT/BRI QUERI focuses on filling gaps and implementing research to improve health outcomes for Veterans with combat-related Traumatic Brain Injury (TBI) that occur in the context of other combat injuries.TBI is a priority area for VHA and of increased prevalence due to the Global War on Terror (GWoT). The cohort that is the primary target of PT/BRI QUERI activities is Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) VA patients.
In this era of modern warfare, America's Armed forces are sustaining new and complex injuries - the majority of which are blast-related. In combat, sources of blast injury include improvised explosive devices (IEDs), artillery, rocket and mortar shells, mines, booby traps, aerial bombs and rocket propelled grenades.
Given the possible effects of explosions on the human body, it is not surprising that blast injuries are often "polytraumatic." Injured body systems and structures include auditory/vestibular, eye, orbit, face, respiratory, digestive, circulatory, central nervous system, renal/urinary tract, extremity, soft tissue, mental health, and pain. Particularly common is Traumatic Brain Injury (TBI). It has been estimated that over 60% of blast-injuries result in TBI and TBI has been labeled the "signature injury" in the Global War on Terror (GWOT). Consequently, best practice for polytrauma requires a focus on TBI in the context of other injuries.
Consistent with the requirements of the overall QUERI program, PT/BRI QUERI has both clinical and implementation science goals. Its highest priority clinical goals are to:
- Ensure that blast-exposed Veterans receive screenings and evaluation for high frequency "invisible" problems, including Traumatic Brain Injury (TBI), Post-traumatic Stress Disorder (PTSD) and other psychiatric problems, pain, and sensory loss (vestibular, hearing, visual impairments).
- Promote identification and evaluation of potentially best practices for polytrauma rehabilitation, including practices that optimize care coordination and transitions across care systems and settings.
- Optimize caregivers'/family members' ability to provide supportive assistance to Veterans with impairments resultant from polytrauma and blast-related injuries.
Reflecting the fact that the evidence base for best practice for blast-related polytrauma is limited relative to common chronic diseases, the Center's implementation science goals have focused on identifying and testing methods for improving practice when the scientific evidence is not well developed and identifying and testing methods for measuring readiness for, adoption of and sustainability of practice improvements.
PT/BRI QUERI coordinates its work with the Physical Medicine and Rehabilitation Program Office (PM&R PO) and the Office of Rehabilitation Services. PT/BRI QUERI investigators disseminate findings through its broad network of affiliates which, in addition to the above, includes the VHA Screening Coordination Workgroup, VA National Polytrauma Pain Subcommittee, VHA Tele-rehabilitation Field Work Group, Polytrauma Rehabilitation Center Family Care Collaborative, DoD-VA Family Transition Task Force, National Center for PTSD, DoD Amputation Patient Care Program and Defense and Veterans Brain Injury Center (DVBIC). Investigators also work closely with the VHA Evidence Synthesis Program.