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Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After
Stephen T Wegener1, Eben A Carroll, Joshua L Gary
1*Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; †Orthopaedic Trauma Service, Wake Forest University Baptist Medical Center, Winston-Salem, NC; ‡Department of Orthopaedic Surgery, McGovern Medical School at UTHealth Houston, Houston, TX; §Department of Orthopaedic Surgery, Methodist Hospital, Indianapolis, IN; ‖Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; ¶The CORE Institute, University of Arizona Medical College - Phoenix, Banner University Medical Center, Phoenix, AZ; **Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ††Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Objectives:
The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC.
Design:
Prospective cohort design.
Setting:
Level-I trauma centers.
Participants:
Attending surgeons and fellows (N = 95 Pre and N = 82 Post).
Main Outcome Measurements:
Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources.
Results:
Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery.
Conclusions:
Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects.
Level Of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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