National Polytrauma System of National Polytrauma System of CareCareandand

VISN 19 Polytrauma System of VISN 19 Polytrauma System of CareCare

Michael Craine, PhDChief, Health Psychology Section, VA Eastern Colorado Health Care SystemCo-Director, Polytrauma Network Site,

VISN 19

Goals of this PresentationGoals of this Presentation

Define Polytrauma Identify the components of the

National Polytrauma Network of Care

Identify the components of the VISN 19 Polytrauma Network of Care

Describe the process of care within the Polytrauma Network

VHA PM&RS Web ResourceVHA PM&RS Web Resource

• Polytrauma System of Care Webpage• http://www.polytrauma.va.gov/

What is Polytrauma?What is Polytrauma?

Blast-related polytrauma is a newly recognized phenomenon – Improvised Explosive Device (IED)

Advances in war have led to advances in medical care – body armor, rapid treatment

This has resulted in survival of individuals with increasingly complex rehabilitation care needs

PolytraumaPolytrauma

• Polytrauma: blast-related injuries to two or more organ systems that result in physical, cognitive, psychological or psychosocial disabilities

• Brain injury (mild, moderate, and severe), PTSD, pain, fractures, hearing loss, spinal cord injury, loss of vision, and burns are common conditions.

In order to meet the In order to meet the complex rehabilitative care complex rehabilitative care

needs….needs….The National Polytrauma

Network of Care has been established

February 05: Four Polytrauma Rehabilitation Centers

December 05: 21 Polytrauma Network Sites

VA TBI and Polytrauma VA TBI and Polytrauma System of CareSystem of Care

March 07 72 Polytrauma Support Clinic Teams, 60 Polytrauma Points of Contact

1992: VHA TBI Lead Centers Selected

July 06: Polytrauma Telehealth Network

April 07: TBI Screening

Components of the National Components of the National Polytrauma Network of CarePolytrauma Network of Care

• Polytrauma Rehabilitation Centers– Richmond VAMC– Tampa VAMC– Minneapolis VAMC– Palo Alto VAMC

• 21 Polytrauma Network Sites (VISN 19-Denver)

• Polytrauma Support Clinic Teams (VISN 19-Grand Junction and Salt Lake City)

• Polytrauma Points of Contact (VISN19-Cheyenne, Sheridan, and Helena)

Care GoalsCare Goals

• PRC – initial rehabilitation• PNS, PCST, POC:• Additional Inpatient/Outpatient

Rehabilitation• Proactive Case Management• Telehealth• Long term follow-up• Care for those who cannot return

home

Components of the VISN 19 Components of the VISN 19 Polytrauma Network of CarePolytrauma Network of Care

VISN 19 Polytrauma Network Site

VA-ECHCS/Denver

Salt Lake VAMCPolytrauma

Support ClinicTeam

Ft. Harrison VAMedical Center:Point of Contact

Grand JunctionVAMC Polytrauma

Support ClinicTeam

Cheyenne VAMedical Center:Point of Contact

Community-Based Out Patient

Clinics

Sheridan VAMedical Center:

Point Of Contact

Characteristics of the Rocky Characteristics of the Rocky Mountain Network: VISN 19Mountain Network: VISN 19

• Most rural network • Geographically, one of the largest networks• Six Medical Centers and 33 outpatient clinics• VA-Eastern Colorado Health Care System provides:

– Care for veterans in Denver metro area and along the I-25 corridor into southeastern Colorado

– Consultative and specialty services for VISN 19

What part is played by What part is played by each component of the each component of the

VISN 19 Network?VISN 19 Network?

VISN 19 Polytrauma VISN 19 Polytrauma Network SiteNetwork SiteVA-Eastern Colorado Health Care VA-Eastern Colorado Health Care

System-DenverSystem-Denver

•Provide specialized interdisciplinary post-acute rehabilitation services; inpatient and outpatient•Continued management of existing and emerging sequelae•Manage rehabilitation plan developed at PRC•Manage new polytrauma patients in consultation with PRC•Identify resources for VA and non-VA care across the VISN

VISN 19 Polytrauma VISN 19 Polytrauma Network SiteNetwork SiteVA-Eastern Colorado Health Care VA-Eastern Colorado Health Care

System-DenverSystem-Denver

•Provide proactive clinical and psychosocial case management; continued support for families•Provide regular follow-up care, check-ups•Active involvement with telehealth•Coordinate services between VHA, VBA, DOD, private sector (fee-basis)

VISN 19 Polytrauma VISN 19 Polytrauma Support ClinicsSupport ClinicsGrand Junction and Salt Lake CityGrand Junction and Salt Lake City

• Established evaluation teams• PSCT= physiatrist, physical therapist,

occupational therapist, speech-language pathologist, psychologist, case manager, others as needed

• Connected to the telehealth network• Primary Role

• Management of stable Polytrauma sequelae

• Proactive follow-up• Consult with VISN PNS and/or regional PRC• Case Management (assigned OIF/OEF case

manager)

VISN 19 Polytrauma VISN 19 Polytrauma Points of Points of ContactContact

Cheyenne, Sheridan, and Cheyenne, Sheridan, and Helena and Community Based Helena and Community Based

Outpatient ClinicsOutpatient Clinics• Identify a point of contact who can act as a

case manager• Identify other providers to take the lead to

complete the TBI screen and follow-up screen as necessary

• Refers to Polytrauma Network of Care for specialty services (for example, assessment and management of TBI, Amputee, PTSD)

Mission StatementMission StatementVISN 19 Polytrauma Network of VISN 19 Polytrauma Network of

CareCareThe VISN 19 Polytrauma Network of Care improves functional abilities, independence and quality of life by

promoting health, change and adaptation.

We provide comprehensive rehabilitation to eligible veterans using an interdisciplinary approach across a

full continuum of care.

We deliver quality care with a commitment to

excellence, trust, respect and compassion.

Let’s look more closely at what Let’s look more closely at what makes up the makes up the VISN 19 VISN 19

Polytrauma Network SitePolytrauma Network Site….….

VISN 19 Polytrauma System of CareVISN 19 Polytrauma System of CareSpecialty Treatment Specialty Treatment

Teams/ProgramsTeams/Programs

VISN 19 Polytrauma Network Site

VA-ECHCS/Denver

Brain Injury Program

PainManagement

PTSDProgram

RehabilitationAnd

OrthopedicPrograms

Audiology Program

AmputeeProgram

Head Injuries

Pain

Emotional Shock

Soft Tissue Trauma

Amputations

Hearing Loss

Blind Rehabilitation

Program

Vision Loss

Spinal Cord InjuryProgram

Cord Injury

Compensated Work Therapy

Program

Vocational

Limitations

InpatientRehab

ProgramAcute

How do we connect facilities How do we connect facilities and providers?and providers?

• Case Management and Care Coordination

• Conference Calls and Mail Groups• Electronic Medical Exchanges through

electronic record• Conferences• Telehealth and Telerehabilitation

– Teleconsultations– Tele Home Health

To whom have we provided To whom have we provided care?care?

• Polytrauma Rehabilitation Centers• As of April 2007, VA has treated over

350 Operation Enduring Freedom and Operation Iraqi Freedom service members in their inpatient units.  The vast majority of these patients have been on active duty at the time of admission, as the major cause of injury has been trauma sustained in combat.

To whom have we provided To whom have we provided care?care?

• 437 patients are currently in VISN 19 Polytrauma Registry

• 302 of those are secondary to a positive TBI Screen

• Nationally, as of mid-June, approximately 3500 referrals secondary to a positive TBI screen have been sent