The traumatic brain injury model systems: history and contributions to clinical service and research

The model systems (MSs) of care for traumatic brain injury (TBI) is a demonstration program started by the National Institute on Disability and Rehabilitation Research in 1987 to improve care and outcomes for individuals with TBI, from emergency services through life-long follow-up. Over the next 20 years, the program increased in size, and the emphasis shifted from demonstration to research. The focal point of that research is the National Data Base, a longitudinal database including nearly 9000 individuals who were admitted for inpatient acute TBI rehabilitation. In addition to preinjury, injury, acute care, and rehabilitation information, the database includes reports of outcomes at 1, 2, 5, 10, 15, etc, years postinjury. The National Data Base criteria, main contents, and mechanisms used to improve data quantity and quality are described. The MSs' other research is described: local (site-specific), module, and collaborative, with illustrative glimpses of the content. The impact of the TBI MSs program, through dissemination, knowledge translation, training of clinicians and researchers, as well as consulting with policy makers, administrators, clinicians, and researchers is discussed.