T he pa tie nt e xpe rie nc e o f tra uma c a re : a tria ng ula - - PowerPoint PPT Presentation

T he pa tie nt e xpe rie nc e o f tra uma c a re : a tria ng ula tio n o f pe rspe c tive s

K AT RI NA O’ L E ARY COL L ABORAT I ON RE SE ARCH PROJE CT MI DL AND T RAUMA RE SE ARCH CE NT RE WI NT E C

Ba c kg ro und

 MT

S b e g a n in 2010 a nd intro duc e d a re g io na l tra uma syste m to the midla nd re g io n

 I

t inc o rpo ra te s a tra uma re g istry tha t is da ta ric h with info rma tio n a b o ut pro c e sse s within ho spita l a nd pre ho spita l

 T

he re g istry info rms re vie ws o f the se pro c e sse s a nd g uide s sub se q ue nt po lic y/ g uide line de ve lo pme nt

 T

he re g istry’ s e ndpo int is pa tie nt disc ha rg e fro m ho spita l

 As a re sult o f the MT

S, we ’ ve se e n mo rta lity re duc tio n within the midla nd re g io n sinc e its c o mme nc e me nt a nd thus survivo rs o f se rio us injury ha ve inc re a se d

 *MT

S-midla nd tra uma syste m

Ba c kg ro und c o ntinue d

 L

a st ye a r 6720 a dmissio ns a c ro ss Midla nd ho spita ls a t a n e stima te d c o st o f $48 Millio n

 2358 a dmissio ns a t Wa ika to ho spita l a lo ne  Que stio ns a rise :  Wha t ha ppe ne d to the se pa tie nts?  Ho w we ll did disc ha rg e suppo rts se t up b y the DHB wo rk?  Wha t a re n’ t we a wa re o f?  Sho uld o ur ma na g e me nt e nd a t pa tie nt disc ha rg e o r sho uld we b e

inc luding lo ng itudina l fo llo w up o f o ur tra uma pa tie nts?

Wha t we kno w

 T

ra uma is o ne o f the hig he st c o ntrib uto rs to mo rta lity, mo rb idity a nd disa b ility a c ro ss a ll a g e ra ng e s a s pe r the Glo b a l Burde n o f Dise a se studie s do ne in 1990 a nd 2000

 T

ra uma syste ms wo rk b y b e ing a b le to pro ve mo rta lity re duc tio n a nd c o nse q ue ntly pa tie nt surviva l po st se rio us injury

 Pa tie nt re c o ve ry is individua l-no t e ve ryo ne will ha ve the sa me

re c o ve ry tra je c to ry

L ite ra ture o ve rvie w- wha t we kno w fro m the lite ra ture

 T

he a c ute pha se -ho me o sta sis b re a c he s (pa in, injurie s), unc e rta in future , c o mmunic a tio n, e xpe c ta tio ns, physic a l limita tio ns, c ha o s (re a l vs no t [me mo ry]), ta ng ib le c o sts (pro pe rty, inc o me lo ss), inwa rd re fle c tio n (b la me / re mo rse / re g re t)

 T

he injury ne g o tia tio n pha se -so c ia l iso la tio n, fa mily impa c ts (c hild c a re / lo ss o f e a rning s/ tra nspo rt), re ha b ilita tio n a c c e ss, lo ng e r te rm physic a l limita tio ns, c o nc o mita nt dise a se (infe c tio n), psyc ho lo g ic a l e ffe c ts (stre ss/ a nxie ty/ PT SD), b e ha vio ura l c ha ng e s (ne g a tive c o ping me c ha nisms), c a re r c o nse q ue nc e s, lo ss

• f fo rme r life , sc ho o l/ study impa c ts

 T

he re c o ve ry/ re c o nc ilia tio n pha se -fe a r, fina nc ia l impa c ts, ne w life a djustme nt, c a re r fa tig ue , se c o nda ry c o nditio n de ve lo pme nt (o ste o a rthritis)

Wha t we do n’ t kno w

 With mo rta lity re duc tio n, a re pa tie nts po te ntia lly living with lo ng

te rm injury impa c ts a nd if so wha t a re the y? Are the y diffe re nt fo r the survivo r a nd fa mily me mb e r?

 Wha t a re the c o mmo nly pe rc e ive d b a rrie rs to re c o ve ry a fte r se rio us

injury?

 Wha t a re we do ing we ll? Wha t e lse sho uld we b e do ing ?  Do e s re c o ve ry a fte r se rio us injury ha ve simila ritie s to c hro nic illne ss?  Are we (DHB’ s, c o mpe nsa to ry a g e nc ie s, prima ry he a lth c a re

pro vide rs) wo rking in silo ’ s in o ur c a re de live ry o f pa tie nts with se rio us injury?

 Wha t a re the ra te s a nd pa tte rns o f re c o ve ry a nd ho w do the se

c ha ng e o ve r time ?

Aim

 T

• e xplo re the e xpe rie nc e o f tra uma c a re fro m the pe rspe c tive s o f

injure d pa tie nts, the ir K SP a nd se rvic e pro vide rs to ide ntify fa c to rs tha t impe de d o r fa c ilita te d re c o ve ry in o rde r to impro ve se rvic e de live ry.

 F

uture a im is to e xpa nd a nd re plic a te this study within a ll 5 DHB’ s o f the Midla nd re g io n +/ - na tio na lly

Me tho do lo g y

 Use o f MT

S tra uma re g istry (po pula tio n b a se d re g istry) to g e ne ra te suita b le

patient candidates based on an eligibility criteria (≥16 yrs age, iss ≥8, no tb i [AI

S b o dy re g io n 1], b lunt tra uma o nly, Wa ika to DHB c a re pro vide r, Wa ika to do mic ile pa tie nt).

 Sa mpling will b e purpo sive to e nsure ma ximum va ria tio n o f the se rio usly injure d

pa tie nt within a g e ra ng e s, e thnic itie s, g e nde r, rura l/ urb a n de mo g ra phic . 4 time pe rio ds po st disc ha rg e (within 1 mo nth, 6 mo nths, 12 mo nths, 24 mo nths).

 T

he pa tie nt’ s will no mina te a K SP a nd se rvic e pro vide r a t initia l c o nta c t to b e inte rvie we d a lso (sa me q ue stio n se t).

 Pa tie nt e xpe rie nc e da ta will b e c a pture d thro ug h pho ne o r fa c e to fa c e

inte rvie ws.

 T

he pa tie nts, K SP, se rvic e pro vide r will b e e nc o ura g e d to spe a k fre e ly a b o ut the ir e xpe rie nc e s a nd pe rc e ptio ns thro ug h the use o f individua l inte rvie ws ra the r tha n fo c us g ro ups.

Me tho do lo g y c o ntinue d

 I

nte rvie ws will b e re c o rde d (with pa rtic ipa nts’ pe rmissio n)

 T

ra nsc riptio n is do ne b y e xte rna l so urc e (c o nfide ntia lity a g re e me nt)

 Onc e tra nsc riptio n is c o mple te , a ll ide ntifia b le da ta is re mo ve d a nd

re pla c e d with a c o de numb e r

 T

ra nsc riptio ns will b e uplo a de d to NVI VO whe re induc tive the ma tic a na lysis will b e imple me nte d b y the re se a rc he r

 K

e y the me s will b e ide ntifie d a nd g ro upe d a s a ppro pria te

 T

he re is a distre sse d pa tie nt pro to c o l

T ime fra me

 Pro je c t to run Se pte mb e r-De c e mb e r 2017  Se pte mb e r-lite ra ture se a rc h, ide ntific a tio n o f po ssib le c o de s fo r

tra nsc riptio n a na lysis, HDE C a ppro va l, pa tie nt ide ntific a tio n thro ug h the MT S re g istry, purpo sive sa mpling , pa tie nt e ng a g e me nt, inte rvie w c o mme nc e me nt, a rtic le writing c o mme nc e me nt

 Oc to b e r-inte rvie ws c o ntinue , inte rvie w tra nsc riptio n, c o de s/ the me s

ide ntifie d with NVI VO, lite ra ture se a rc h, a rtic le writing c o ntinue s

 No ve mb e r-o ng o ing the ma tic a na lysis, c o de s/ the me s c he c ke d b y

2nd re se a rc he r fo r rig o ur, a rtic le writing c o ntinue s, re po rt fo r sta ke ho lde rs

 De c e mb e r-fina l pro je c t c o mple tio n, a rtic le re a dy fo r jo urna l

sub missio n

Pro je c t e nd

 I

mpro ve d unde rsta nding o f the q ua lity o f surviva l o f pa tie nts with se rio us injury up to 2 ye a rs po st e ve nt

 Be a b le to ide ntify re c o ve ry pa tte rns a nd time fra me s to info rm

he a lthc a re , so c ia l, a nd disa b ility se rvic e pro visio n.

 Be a b le to ide ntify the impa c t upo n the pa tie nt’ s ke y suppo rt

pe o ple

 Asc e rta in if this study c a n b e fe a sib ly re plic a te d a c ro ss the Midla nd

re g io n

 Will ta ke b a c k ke y le a rning s to my o wn pra c tic e a s a T

ra uma CNS

 Will sha re le a rning s within c linic a l te a ms in the Midla nd re g io ns’

T ra uma Se rvic e s