TBI process maps - Feb 2018

<p>The following are included in this publication: 1) Overall TBI Process Map; 2) NCAA Sports Medicine Process Map; 3) Acute Care Process Map; 4) Inpatient Rehabilitation Process Map; 5) Outpatient Rehabilitation. These maps are products of a PhD thesis deposited Spring 2018 ("Information and coordination for tracking traumatic brain injury recovery: A functional needs assessment," Siobhan M. Heiden, School of Industrial Engineering).<br />
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ABSTRACT</p>

<p>Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually. Over 5.3 million persons in the US are living with a TBI-related disability, which costs about $60 billion annually. TBI is a multi-dimensional injury that requires multi-disciplinary care teams to coordinate and deliver care. Due to the unique symptoms and outcomes of each TBI patient, rehabilitation must be highly tailored and individualized. Clinicians want to know if their treatments for a specific patient are effective for that patient. The goal of this research is to determine the data needed for clinical decision support tools that would allow rehabilitation professional teams to track the short-term and long-term recovery of TBI survivors in a timely and effective manner. Specifically, this dissertation’s overarching goals are to: 1) map the processes of TBI rehabilitation with providers at each process stage; 2) define the roles of each provider and their expertise; 3) specify the information needs for each provider and their information flows in the process over time; and 4) consider future technological advances that might benefit care delivery coordination in this process. This functional needs assessment used semi-structured interviews (n = 32) to determine the needs of the professional care providers involved in the rehabilitation process for adult civilian TBI survivors.</p>

<p>The findings from this work informed process maps, which were useful in understanding team coordination, and highlighted the information handoffs that occur at various levels of the system (e.g. shift-change level, healthcare system transfer level). Content analysis identified process characteristics, such as differences in TBI care in athletic programs versus purely clinical settings. This analysis also identified and defined over 30 key professional roles, their expertise, and their information needs. Provider role definitions highlighted the criticality of multi-disciplinary teamwork due to the need for different perspectives and consistency of treatment. Thus, the coordination and communication in TBI response, recovery, and rehabilitation may need to be even more robust than in some other disease populations. While each professional role in TBI rehabilitation varies in their information needs, there was a general consensus in wanting to know “everything” about the patient. Certain information types and formats are prioritized differently for each TBI professional. All professionals want timely information, although their time-scales for what is considered “timely” varied. In general, the earlier the patient is in the care continuum, the more frequent information updates (i.e., multiple updates per hour or day) for providers are desired/necessary. Finally, barriers and facilitators to care were identified. The findings from two use cases informed information architectures for building a system that can house the various data formats of professionals’ information needs and support their sensemaking and coordination with other providers in TBI rehabilitation.</p>

<p>Recommendations for improvement and areas for future work include telehealth and telemedicine interventions, automated patient data collection, information system (re)design, resource allocation analysis, and macro-ergonomic handoff research. Just as no one clinical discipline “owns” TBI care, the numerous functional needs identified in this study cannot be addressed by one discipline or field. There are numerous research and development opportunities for persons from multiple disciplines and fields, especially engineering; they are invited to join the “team” in improving the complex system that is TBI rehabilitation.</p>

本出版物收录以下内容：1）整体创伤性脑损伤（Traumatic Brain Injury, TBI）流程图谱；2）美国全国大学体育协会（National Collegiate Athletic Association, NCAA）运动医学流程图谱；3）急诊护理流程图谱；4）住院康复流程图谱；5）门诊康复流程图谱。上述图谱源自2018年春季提交的博士学位论文《创伤性脑损伤康复追踪中的信息与协调：一项功能需求评估》（Siobhan M. Heiden，工业工程学院）。

摘要

创伤性脑损伤（Traumatic Brain Injury, TBI）每年影响约170万美国人。美国现有超过530万人携带TBI相关残疾，每年相关医疗支出约600亿美元。TBI属于多维度损伤，需要多学科护理团队协同开展诊疗工作。由于每位TBI患者的症状与转归均存在特异性，康复干预必须高度定制化、个体化。临床医师希望明确针对特定患者的治疗方案是否对该患者有效。本研究旨在明确临床决策支持工具所需的数据，以使康复专业团队能够及时且高效地追踪TBI幸存者的短期与长期康复进程。本论文的核心目标具体包括：1）结合各流程阶段的医护人员，绘制TBI康复流程图谱；2）明确各医护人员的职责与专业能力；3）细化各医护人员的信息需求及其在流程中的动态信息流转路径；4）探讨可优化该流程中诊疗协调的未来技术进展。本次功能需求评估采用半结构化访谈（semi-structured interviews，样本量n=32），调研了参与成年平民TBI幸存者康复流程的专业医护人员的需求。

本研究的成果为流程图谱的绘制提供了依据，这些图谱有助于理解团队协作模式，并凸显了系统各层级（如交接班层级、医疗体系转诊层级）中存在的信息交接问题。通过内容分析（content analysis），本研究明确了TBI护理的流程特征，例如运动医学场景与纯临床场景下的TBI护理差异。本次分析还确定并界定了30余个核心专业角色、各自的专业能力及信息需求。医护人员的职责定义凸显了多学科团队协作的重要性——这源于对不同视角的需求以及诊疗一致性的要求。因此，TBI的应急处置、康复恢复与康复治疗环节中的协调与沟通，可能需要比其他多数疾病群体更为完善。尽管TBI康复领域的各专业岗位对信息的需求各不相同，但所有参与者均普遍希望掌握患者的“全部信息”。不同TBI医护人员对信息类型与格式的优先级排序存在差异。所有医护人员均期望获取及时的信息，但他们对“及时”的时间尺度定义各不相同。总体而言，患者所处的护理连续体（care continuum）阶段越早，医护人员越需要或期望获取更频繁的信息更新（即每小时或每日多次更新）。最后，本研究明确了护理工作的障碍与促进因素。两项应用场景的研究成果为信息架构的构建提供了参考，该系统可存储医护人员信息需求对应的各类数据格式，并支持TBI康复过程中医护人员的信息解读与跨团队协作。

本研究提出的改进建议与未来研究方向包括：远程医疗（telehealth）与远程医学（telemedicine）干预、患者数据自动化采集、信息系统（再）设计、资源分配分析以及宏观工效学（macro-ergonomic）交接研究。正如没有任何单一临床学科能够“独占”TBI护理工作，本研究中识别出的大量功能需求也无法由单一学科或领域单独解决。多学科、多领域的研究者（尤其是工程领域）拥有大量研发机遇；诚邀各方加入“团队”，共同优化TBI康复这一复杂系统。