EDucate: Improving In-Hospital and Post-Discharge Patient Education for Mild Traumatic Brain Injury

Lay Abstract Mild traumatic brain injury (mTBI) is extremely common and causes disruptive symptoms for Military Service Members, Veterans, and civilians. Experts agree that individuals diagnosed with mTBI in emergency departments should be given education about the symptoms to expect, “Red Flag” symptoms that warrant return to the emergency department, and information about their prognosis and how to balance rest and activities to optimize their recoveries. Unfortunately, many patients who are diagnosed with mTBI in emergency departments do not get recommended education. This results in patients being ill-equipped to manage their symptoms and injury-related problems and often unable to secure needed follow-up care for mTBI. This 3-year community-engaged Health Service Research Award will advance knowledge and tools to improve the education and care coordination of adults with mTBI in emergency departments and after discharge. Our primary aims are to (1) identify the barriers and facilitators to emergency department providers giving patients mTBI educational information before discharge, (2) test the hypothesis that targeted strategies tailored to these contextual barriers increase the provision of mTBI education in the emergency department, and (3) evaluate the impact of mTBI education on patient outcomes, considering both emergency department education and use of novel text/email-based tool that provides education and personal support from a nurse care coordinator. The project reflects years of prospective observational research and relationship building among our multi-institutional partners comprising an academic medical center, non-profit hospital system, and independent private company dedicated to promoting digital healthcare. Our community-engaged team comprises diverse academic researchers, clinicians, patient stakeholders, hospital administrators, and other partners to seek practical, scalable solutions to improving the acute and subacute care of the large, diverse mTBI patient population. This work directly addresses Focus Area 3 (Treat) of the FY23 TBIPHRP HRSA award by seeking to increase provider adoption of evidence-based interventions (Focus Area 3C) and investigating mobile health technologies that could be deployed to resource-limited environments (Focus Area 3A). This work will be executed across a major midwestern healthcare system comprising 1 academic level I trauma center, 2 level III community hospitals, and 5 non-trauma-rated community hospitals with diverse patient characteristics, clinical staffing structures, and resources. This design will support strong transferability of findings to diverse environments relevant to Military Service Members, Veterans, and civilians. The work addresses major goals of the Military Health System to identify practical, efficient strategies to improve the acute and post-acute care of deployed Service Members, for whom busy acute trauma environments and diverse care pathways make it challenging to deliver even basic patient education consistently. Furthermore, because at least half of nondeployed active-duty Service Members are diagnosed in EDs, this project’s focus on 8 diverse EDs will provide information to improve settings where many Service Members are diagnosed and treated with mTBI. Finally, the project’s advancement of mobile health technology will promote new strategies for managing mTBI in under-resourced areas such as rural and far-forward military environments.