Results Summary

What was the research about?

Each year, millions of Americans have injuries serious enough that they need to stay in the hospital. These injuries may be from car and motorcycle crashes, falls or other accidents, or gunshot or stab wounds.

In this study, the research team wanted to learn about ways to help patients after a serious injury. A member of the research team talked with patients in the study while they were still at the hospital after their injuries to learn about their concerns.

The team compared two approaches to supporting patients with the concerns they raised:

  • Care management. Care managers worked closely with the patients in this group. They created a plan for patients’ health care and helped patients get the type and amount of care that they wanted. Care managers gave extra support to patients with symptoms that were more serious, such as helping them get mental health care when needed. The research team also gave patients a phone number to call if they had questions or wanted to talk at any time.
  • Nurse alert. The team told the hospital nurses about the concerns that the patients in this group raised.

What were the results?

Patients in the care management group had fewer serious concerns over the course of the study than patients in the nurse-alert group did. In the three to six months after their injuries, patients in the care management group had fewer visits to the emergency room, or ER, than patients in the nurse-alert group did. But the team found no difference when comparing ER visits between groups over the full year.

There was no difference between the two groups in how many patients had symptoms of depression or posttraumatic stress disorder. Patients in each group reported similar physical health, quality of life, and satisfaction with their care. They also reported engaging in a similar amount of risky behaviors such as alcohol and drug use.

Who was in the study?

The study included 171 patients who stayed in the hospital for at least one day after a serious injury. Patients reported having at least three serious concerns after their injuries. Patients in the study were 14 years old or older, and the average age was 42. Of the 171 patients, 57 percent were female, 56 percent were white, 16 percent were African American, and 13 percent were American Indian.

What did the research team do?

The research team assigned patients by chance to either the care management group or nurse-alert group. In both groups, the team interviewed patients at one, three, and six months after their injuries. The team also looked at how often patients went to the ER during the first year after their injuries.

What were the limits of the study?

The study was at one hospital that treats people with serious injuries in Washington State. Results may be different in other places or other types of hospitals. Patients in the study had trouble remembering all the concerns they had between interviews, making it hard for the team to assess the full number of patient concerns. The care management program did a number of things for patients. As a result, it was hard for the team to know which parts of care management helped patients the most.

Future research could include patients from other places and look more closely at ER use.

How can people use the results?

Trauma centers can consider offering care management programs like the one in this study to help reduce patients’ concerns after a serious injury.

Final Research Report

View this project's final research report.

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Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, the PI made changes including

  • Providing additional detail about how the stakeholder team input affected the study protocol and how the membership of the stakeholder team changed during the study.
  • Adding a table to the Methods section to describe the interventions to be compared in response to reviewer comments that the section had been difficult to follow.
  • Including additional information about prespecified statistical analyses, how patient subgroups were formed and the related analyses, and characteristics of the measures used to assess outcomes, in order to better address the PCORI Methodology Standards.
  • Detailing the qualifications and training of the research assistants who conducted patient assessments. The researchers reported favorable postintervention feedback from patients about the research assistants.
  • Describing further the measurement of patient concerns at the 3- and 6-month post-injury follow-up.

Conflict of Interest Disclosures

Project Information

Douglas F. Zatzick, MD
University of Washington
A Comparative Effectiveness Trial of Optimal Patient-Centered Care for US Trauma Care Systems

Key Dates

September 2013
September 2017

Study Registration Information


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Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: March 14, 2024