A patient-centric approach to neuro-recovery after acute brain injuries

Patients discharged after acute brain injuries require ongoing medical care to support recovery and treat secondary neurologic complications. Most therapeutic trials for interventions after acute brain injuries use measures of disability (i.e., the Modified Rankin Scale) as primary outcomes, but systematically collecting these outcomes as part of clinical care remains challenging. In addition, understanding patients' perspectives on recovery is critical to providing personalized care and ultimately improving outcomes.

The Post-ICU Neurorecovery clinic at a tertiary care hospital documented two outcome measures as part of routine clinical care: 1) Modified Rankin Scale (mRS), and 2) Free-text response to "What is the single most important thing the NeuroRecovery clinic can do to support you/your loved one in the journey of recovery". Weekly clinic reminders to providers to use a SmartPhrase that integrated these outcome measures into clinical documentation was implemented. A qualitative content analysis of the SmartPhrase responses was conducted. mRS scores were examined in relation to results from qualitative content analysis.

After the implementation of weekly clinical email reminders, documentation of the smartphrase improved from 29 % to 60 % for all clinic visits over a pilot period of 11 months (July 2022-May 2023). Physical health (n = 82, 37 %), functional recovery (n = 37, 17 %), mental health (n = 31, 14 %), and social health (n = 18, 8 %) were the most common themes (codes) abstracted from the free-text responses. Themes varied by mRS levels; as mRS scores increased (i.e., increased disability), patients reported greater need for physical health support.

Standardized, systematic documentation of outcomes in Neurorecovery clinics may provide an opportunity to develop patient-centric and disability level-specific goals for recovery.