Trauma Collaborative Care program may not have meaningful impact on outcomes at 1 year
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The Trauma Collaborative Care program may not have meaningful impact on patient outcomes at 1 year compared with standard of care treatment, according to published results.
Researchers assessed short musculoskeletal function assessment dysfunction index, patient health questionnaire-9 and PTSD checklist at 1-year follow-up among patients with high-energy orthopedic trauma requiring surgical fixation who received either Trauma Collaborative Care (TCC) intervention combined with program and services provided by the Trauma Survivors Network (n=378) or standard of care (n=344). Researchers used a two-stage, Bayesian hierarchical statistical procedure to characterize treatment effects and conducted sensitivity analysis to account for an error in the delivery of the intervention.
Results showed 29% of patients in the intervention group received all five key components, including Trauma Survivors Network handbook education, peer visits, recovery assessment and calls before and after recovery assessment. The posterior estimates of the intention-to-treat effect showed that the intervention did not have an appreciable effect, with the odds of the composite outcome for the TCC group increased by 5%. Researchers also noted similar estimates of the effect of receiving all five key intervention components.
“Despite showing early positive effects at 6 weeks, the results of this analysis did not support our hypothesis that the TCC program would result in lower rates of poor function, depression and PTSD. Rather, the findings suggest that the TCC as delivered does not have appreciable effects on 1-year outcomes in this patient population,” the authors wrote. “Given the resource intensity of this comprehensive intervention, alternative models need to be explored to address the psychosocial challenges of individuals following orthopedic trauma.”
Perspective
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We have to remind ourselves that we meet many of our trauma patients on the worst day of their lives. Furthermore, the Lower Extremity Assessment Project study showed us that outcomes are more affected by a patient’s economic and social resources than how well we fixed their leg. Issues such as PTSD and depression after trauma can not only predict outcomes but can be managed with appropriate early intervention. For example, the TCC intervention has served this need but has not been studied on a large scale in comparison with standard of care. The Major Extremity Trauma Research Consortium reported its findings of such an investigation across six trauma centers in “The 12 Month Effects of the Trauma Collaborative Care Intervention” in the Journal of Bone and Joint Surgery. Unfortunately, and somewhat surprisingly, the TCC program did not demonstrate positive effects on patient outcomes at 1 year. It was noted that utilization of TCC overall was low, which might have played a role in their results. My impression is that this should not close the door on our attempts at addressing psychosocial needs. Rather, we need to better understand how to manage these needs and how to minimize stigma associated with these needs in order to facilitate better access to care.
Reference:
Bosse M, et al. N Engl J Med. 2002;doi:10.1056/NEJMoa012604.
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