Research Projects

VCU's TBI MODEL SYSTEM GRANT

With an estimated annual incidence rate of 1.7 million, traumatic brain injury is a leading cause of death and disability in the United States. Annually, brain injury accounts for 53,000 deaths, 325,000 hospitalizations and more than one million visits to U. S. emergency rooms. Brain injury causes drastic life changes, with losses affecting survivors, their families, and society. An estimated 5.3 million people in the United States live with permanent brain injury-related disabilities. Estimates place the annual indirect and direct financial costs above $75 billion.

Traumatic Brain Injury Model Systems (TBIMS) and other researchers have expended considerable energy delineating outcomes. For example, researchers have thoroughly documented postinjury memory disturbance, executive skills dysfunction, slowness, visual dysfunction, poor coordination, impaired self-awareness, and behavioral disorders. Recent studies have identified a high prevalence of depression, with many survivors reporting feelings of hopelessness, diminished self-esteem, and social isolation. Undoubtedly brain injury also affects couples and family systems. Caregivers commonly describe emotional distress, lack of respite, financial stress, and lack of community support.

The Virginia Traumatic Brain Injury Model System (TBIMS) conducts rigorous research to improve outcomes for individuals with TBI and their families. Our current work includes Improving Traumatic Brain Injury Rehabilitation Care With Community Health Services, a randomized controlled trial evaluating whether pairing care partners with community health workers enhances caregiver well-being, preparedness, and patient outcomes. We also contribute longitudinal data to the TBI Model Systems National Database and participate in the LifeCourse and State Programs and Supports Collaborative Module projects.

Home to this TBIMS program is Virginia Commonwealth University (VCU), a major provider of brain injury acute care and medical rehabilitation services for more than three decades. We have been an active collaborator in the brain injury model system program since 1987. Since program inception, we have: extended our system of care; developed new partnerships with service providers and advocacy organizations; improved outcome measurement techniques; and explored the development of innovative interventions. Consumer involvement, community-based rehabilitation, relevance, and active dissemination to consumer and professional audiences have been cornerstones of program development and implementation.

Centrally located in Virginia, the university is a major provider of medical services to a large, culturally diverse population. As the state’s largest single provider, VCU Health provides nearly one-third of Virginia’s indigent care. Uninsured patients represent 20 percent of all patients treated, substantiating our strong commitment to serve persons regardless of ability to pay. The VCU Rehabilitation Center is a components of the VCU Health, a major state-supported teaching institution. The more than 350 model systems manuscripts published by our interdisciplinary research team in the past 30 years substantiates assertions that the urban, academic health center setting is ideal for scientific research, innovation, collaboration, and dissemination.

Improving Traumatic Brain Injury Rehabilitation Care Transitions With Community Health Services: A Randomized Clinical Trial (CHW Intervention for TBI Care Transitions [CHWI for TBI]), a Research Project Within the TBI Model System

Once people with TBI and their care partners enter the post-acute care landscape, they must navigate fragmented health care systems, interact with providers who may be unfamiliar with TBI, and discover their own services and supports. Inpatient rehabilitation provides high levels of structure and professional support that are impossible to replicate when constructing a home environment to independently manage day-to-day care. Once home, the person with TBI's physical, cognitive, behavioral, and medical needs can easily overwhelm even the most committed care partners. Community health workers (CHWs) through a combination of care coordination, advocacy, and direct service delivery, have the potential to address TBI care partners' needs, particularly those from low income and/or traditionally underserved minority groups. CHWs are well-suited to fill resource gaps that TBI care partners have difficulty finding, including: (1) finding diagnostic, treatment, and social services; (2) assisting with referrals; (3) providing health education and motivational interviewing to support behavioral health change; (4) collecting and managing clinical data; (5) facilitating productive relationships between health services and communities, and (6) offering psychosocial support.

THE NATIONAL DATABASE

Since 1987, model system researchers have been working hard to learn more about the effects of brain injury. They collect information from emergency room records, acute care physicians, and rehabilitation physicians. They also collect information from persons with brain injury. Information relating to the following categories is collected for the national database and analyzed -

injury severity – CT scan results, Glasgow Coma Scale scores, types of surgery
cause of injury
duration of hospitalization and rehabilitation
rehabilitation progress – ability to carry out activities of daily living independently
work status before and after injury

Information from the database has helped model systems researchers learn how recovery is affected by factors such as age, cause of injury, injury severity and duration of hospitalization. As more information is entered into the database, researchers have greater opportunities to learn about effective treatment approaches. More information abou the National Database can be found at www.tbindsc.org.