To compare the effectiveness of care management versus enhanced usual care to prevent postinjury concerns and symptoms for hospitalized patients with serious injuries
|Randomized controlled trial
|171 patients ages 14 and older, hospitalized with a serious injury
- Care management
- Enhanced usual care for trauma patients, including notifying nurses of patients’ postinjury concerns
Primary: number of serious postinjury concerns, PTSD symptoms, depressive symptoms
Secondary: physical health, quality of life, emergency department use, satisfaction with care, risk behaviors
|6-month follow-up for primary outcomes
This randomized controlled trial compared care management with enhanced usual care for hospitalized patients with serious injuries.
The study included 171 hospitalized patients in a level 1 trauma center in the Pacific Northwest who reported substantial postinjury distress. Serious injuries included motor vehicle, pedestrian, and bicycle accidents (50%); falls (31%); and intentional injuries from physical assaults, including gunshots and stabbings (14%). The average age of the 171 patients was 42, and 57% were female. The study included patients who were white (56%), African American (16%), and American Indian (13%).
Researchers randomly assigned participants to either the care management group or the enhanced usual care group. In both groups, researchers interviewed participants at baseline to understand their primary postinjury concerns. In the care management group, a care manager worked with patients to develop individualized treatment plans based on the patients’ care preferences. The care managers provided ongoing support to patients, including providing a contact number and encouraging them to call at any time. In addition, the care managers provided support and referrals to patients who presented with symptoms of depression, posttraumatic stress disorder (PTSD), alcohol use problems, or other risk behaviors. In the enhanced usual care group, researchers notified the patients’ nurses about the concerns the patients shared at baseline for further follow-up as deemed necessary by the nurses.
Researchers interviewed patients in both groups again at one, three, and six months after their injuries. In addition, researchers monitored patients’ emergency department visits for one year.
Patients, clinicians, patient advocates, and policy makers worked with researchers and provided input on the study design and implementation.
Patients in the enhanced usual care group were more likely than patients in the care management group to report one or more serious concerns over the course of the study (p=0.01) and at six months postinjury (p=0.02). Researchers found no clinically or statistically significant differences between the two groups for PTSD or depressive symptoms.
Patients in the care management group had fewer emergency department visits three to six months postinjury compared with those in the enhanced usual care group (p=0.03), but there was no statistically significant difference over a full year. Researchers also found no statistically significant differences between groups for physical health, quality of life, satisfaction with care, or risk behaviors.
Patients found it difficult to remember all their postinjury concerns between the data collection time points and, as a result, may not have reported all concerns.
Because there were many components to the intervention, it is difficult to know which parts of the care management approach led to reductions in postinjury concerns and emergency department use three to six months after the injury. In addition, because the study occurred at a single trauma center, the findings may not be generalizable to other areas or settings.
Conclusions and Relevance
Patients with a serious injury who received care management had fewer postinjury concerns and fewer visits to the emergency department three to six months after their injuries than patients who received enhanced usual care. Trauma centers may consider offering care management services to help reduce patients’ concerns after a serious injury.
Future Research Needs
Future studies could examine which features of the care management intervention led to reductions in postinjury concerns and further investigate differences in emergency department use.