Description
The following are included in this publication: 1) Overall TBI Process Map; 2) NCAA Sports Medicine Process Map; 3) Acute Care Process Map; 4) Inpatient Rehabilitation Process Map; 5) Outpatient Rehabilitation. These maps are products of a PhD thesis deposited Spring 2018 ("Information and coordination for tracking traumatic brain injury recovery: A functional needs assessment," Siobhan M. Heiden, School of Industrial Engineering).
ABSTRACT
Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually. Over 5.3 million persons in the US are living with a TBI-related disability, which costs about $60 billion annually. TBI is a multi-dimensional injury that requires multi-disciplinary care teams to coordinate and deliver care. Due to the unique symptoms and outcomes of each TBI patient, rehabilitation must be highly tailored and individualized. Clinicians want to know if their treatments for a specific patient are effective for that patient. The goal of this research is to determine the data needed for clinical decision support tools that would allow rehabilitation professional teams to track the short-term and long-term recovery of TBI survivors in a timely and effective manner. Specifically, this dissertation’s overarching goals are to: 1) map the processes of TBI rehabilitation with providers at each process stage; 2) define the roles of each provider and their expertise; 3) specify the information needs for each provider and their information flows in the process over time; and 4) consider future technological advances that might benefit care delivery coordination in this process. This functional needs assessment used semi-structured interviews (n = 32) to determine the needs of the professional care providers involved in the rehabilitation process for adult civilian TBI survivors.
The findings from this work informed process maps, which were useful in understanding team coordination, and highlighted the information handoffs that occur at various levels of the system (e.g. shift-change level, healthcare system transfer level). Content analysis identified process characteristics, such as differences in TBI care in athletic programs versus purely clinical settings. This analysis also identified and defined over 30 key professional roles, their expertise, and their information needs. Provider role definitions highlighted the criticality of multi-disciplinary teamwork due to the need for different perspectives and consistency of treatment. Thus, the coordination and communication in TBI response, recovery, and rehabilitation may need to be even more robust than in some other disease populations. While each professional role in TBI rehabilitation varies in their information needs, there was a general consensus in wanting to know “everything” about the patient. Certain information types and formats are prioritized differently for each TBI professional. All professionals want timely information, although their time-scales for what is considered “timely” varied. In general, the earlier the patient is in the care continuum, the more frequent information updates (i.e., multiple updates per hour or day) for providers are desired/necessary. Finally, barriers and facilitators to care were identified. The findings from two use cases informed information architectures for building a system that can house the various data formats of professionals’ information needs and support their sensemaking and coordination with other providers in TBI rehabilitation.
Recommendations for improvement and areas for future work include telehealth and telemedicine interventions, automated patient data collection, information system (re)design, resource allocation analysis, and macro-ergonomic handoff research. Just as no one clinical discipline “owns” TBI care, the numerous functional needs identified in this study cannot be addressed by one discipline or field. There are numerous research and development opportunities for persons from multiple disciplines and fields, especially engineering; they are invited to join the “team” in improving the complex system that is TBI rehabilitation.
Cite this work
Researchers should cite this work as follows:
- Heiden, S. M. (2018). TBI process maps - Feb 2018. Purdue University Research Repository. doi:10.4231/R7RJ4GP8