Collaborative Care for Injured Older Adults: The Trauma Medical Home Randomized Clinical Trial

Area of Science:

• Geriatric Trauma Care
• Biopsychosocial Health
• Collaborative Care Models

Background:

• Older adults experiencing injuries often face long-term challenges in biopsychosocial functioning.
• Interventions tailored to the specific needs of this demographic are crucial for improving outcomes.
• The Trauma Medical Home (TMH) model offers a potential solution for integrated care.

Purpose of the Study:

• To evaluate the effectiveness of the TMH collaborative care intervention.
• To determine if TMH improves biopsychosocial function in older adults one year post-injury.
• To assess impacts on quality of life, mental health, and physical function.

Main Methods:

• A single-blinded, randomized clinical trial involving 430 patients aged 50+ with an Injury Severity Score (ISS) of 9 or greater.
• The intervention group received 6 months of TMH care coordinated by a nurse and an interdisciplinary team.
• Primary outcomes included SF-36 and Short Physical Performance Battery (SPPB) scores at 12 months; secondary outcomes included PHQ-9 and GAD-7 scores.

Main Results:

• No significant differences were observed between the TMH and usual care groups in SF-36 or SPPB scores at 12 months.
• Secondary outcomes, including depression (PHQ-9) and anxiety (GAD-7) scores, also showed no significant differences.
• A planned subgroup analysis indicated that patients with high baseline anxiety or depression symptoms (high GAD-7 and PHQ-9 scores) showed improvement in mental component summary scores with TMH.

Conclusions:

• The TMH intervention did not demonstrate a significant overall improvement in the biopsychosocial function of older adults post-injury.
• A positive impact was noted in a subgroup of patients experiencing significant anxiety and depression symptoms at enrollment.
• Further research is warranted to explore the potential of collaborative care models for specific patient populations in trauma recovery.