Survivors of improvised explosive device attacks often have traumatic brain injuries (TBIs). Those recovering from TBIs often find they must coordinate services across multiple systems of care, something that would be difficult even without cognitive challenges. This report documents RAND's assessment of a program designed to facilitate care coordination for such individuals.
The Defense and Veterans Brain Injury Center Care Coordination Program
Assessment of Program Structure, Activities, and Implementation
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Research Questions
- What is the history of the Defense and Veterans Brain Injury Center Care Coordination Program, and how has it been implemented?
- Who are the target beneficiaries, and how does the program reach out to them?
- What barriers to and facilitators of successful care coordination of traumatic brain injury services appear to exist?
- What lessons have staff members learned that might serve as valuable resources for other care coordination programs?
Improvised explosive devices have been used extensively against U.S. forces during Operation Enduring Freedom and Operation Iraqi Freedom and have been one of the leading causes of death. Injuries among survivors often include traumatic brain injuries (TBIs). Those recovering from TBIs often find they must coordinate services across multiple systems of care to meet all their medical and psychological health needs. This task is difficult even for those without the cognitive challenges associated with TBI and may prove overwhelming or even impossible, particularly during periods of transition from inpatient to outpatient services or from active duty to veteran status, for example. Although case management and care coordination are readily available for those who have experienced a severe TBI, fewer resources are available for those with symptomatic mild and moderate TBI. This report focuses on a program designed to facilitate care coordination for individuals with mild and moderate TBI, the Defense and Veterans Brain Injury Center Care Coordination Program. It summarizes RAND's assessment of the program's structure, activities, and implementation. To address the goals above, the authors conducted semistructured interviews in person with program administrators and via telephone with regional care coordinators. The subsequent analysis identified innovative practices, continuing challenges, and lessons learned. The recommendations provided here suggest strategies for meeting these challenges while maintaining the benefits possible through this novel approach to care.
Key Findings
The Program Bridges Systems of Care and Geographic Regions
- Unlike care coordinators affiliated with a specific military treatment facility, this program's regional care coordinators (RCCs) can follow a traumatic brain injury (TBI) patient transitioning from an inpatient facility to outpatient services, leaving active duty and entering the Veterans Administration (VA) system, or making a permanent change of station.
- These transitions are critical periods in which service members with TBIs may drop out of services.
Decentralization Has Advantages
- RCCs are closer to their caseloads than they would be if centralized and are able to reach out to and develop expertise on their regions more easily.
Sharing Information Across Military, VA, and Community Systems Remains a Challenge
- Gap-bridging programs for other service member populations would likely face similar challenges.
The Program Employs Licensed, Clinically Skilled Care Coordinators with Unique, TBI-Specific Expertise
- All RCCs are clinically trained and licensed.
- RCCs' unique expertise in TBI allows them to provide education to service members and their families that is precisely targeted to their questions, concerns, and needs.
Historically, the Program Has Gained Patients Based on Referrals from Landstuhl but Needs to Improve Its Outreach for the Future
- As current operations overseas wind down, fewer referrals are coming from traditional sources. This does not mean services are less needed.
- Among other things, the program should improve its online presence, especially making its web pages more clear and informative, especially for those whose very injuries may affect cognitive functioning.
Recommendations
- Expand opportunities for regional care coordinator (RCC) training across health systems.
- Facilitate uniform access to relevant medical records and health information.
- Continue to develop centralized data and information-sharing tools.
- Continue to address variation across sites related to multiple lines of authority.
- Clarify core features of the program and assess fidelity to them.
- Consider the value of the decentralized, regional system of RCC sites.
- Clarify funding available to RCCs to promote outreach.
- Consider alternative staffing models to facilitate outreach.
- Develop clear, standardized program materials at the headquarters level that all RCCs can use in outreach efforts.
- Consider changing the program name and the job title of regional care coordinators to better align with program services and to reflect a focus on traumatic brain injury (TBI).
- Create a uniform web presence that is easy to navigate.
- Leverage additional TBI screening data to identify service members who may benefit from program services.
- Evaluate outcomes.
Table of Contents
Chapter One
Introduction
Chapter Two
Structure and Infrastructure of the DVBIC Care Coordination Program
Chapter Three
Regional Care Coordinators
Chapter Four
Program Eligibility and Population Served
Chapter Five
Outreach and Branding
Chapter Six
Recommendations and Conclusions
Appendix
Methods for Content Analysis of the CCP Web Presence on DVBIC Websites
Research conducted by
The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.
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