Comparative Effectiveness Research Protocol

Project Type
Principal Investigator Name
Shahid Shafi, M.D., MPH
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The broad aim of our research is to improve functional outcomes of patients with TBI utilizing comparative effectiveness research (CER). The current project aims to identify variations in clinical practices and patient outcomes and identify evidence-based best clinical practices in acute rehabilitation of TBI patients. Traumatic brain injury is a leading cause of death, disability, and years of productive lives lost. Patients with significant neurologic and functional deficits after TBI are treated at inpatient rehabilitation centers. Comprehensive rehabilitation has been shown to improve functional outcomes and successful reintegration of TBI patients into the community. This project has three specific aims: Specific Aim 1: To measure variations in patient outcomes across TBIMS centers. To achieve this aim, we will use TBIMS multicenter data to measure patient outcomes at discharge from inpatient rehabilitation using Disability Rating Scale (DRS) and Functional Independence Measure (FIM). Outcomes will be adjusted for patient characteristics that may affect their outcomes such as age, severity of TBI, computed tomography (CT) scan findings, duration of post-traumatic amnesia, pre-injury functional status, and functional status at the time of rehabilitation admission. Specific Aim 2: To measure variations in inpatient rehab treatment across TBIMS centers. To achieve this aim, we will obtain a representative sample of patients from 4 centers and measure type, intensity, and duration of specific rehabilitation interventions provided during inpatient stay. Interventions will be grouped by rehab disciplines (eg, physical/occupational, speech/language, cognitive, medical, psychosocial, social work/case management) and their impact on patient outcomes will be measured. Specific Aim 3: To develop a set of evidence-based best practices for inpatient rehabilitation of TBI patients. To achieve this aim, we will undertake a systematic review of literature to develop a list of recommended practices. We will then refine and update this list utilizing Delphi methodology through a panel of experts and patients/families drawn from TBIMS centers.