National Polytrauma System of Care and VISN 19 Polytrauma System of Care

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National Polytrauma System of CareandVISN 19
Polytrauma System of Care

• Michael Craine, PhD
• Chief, Health Psychology Section, VA Eastern
  Colorado Health Care System
• Co-Director, Polytrauma Network Site, VISN 19

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Goals 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

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VHA PMRS Web Resource

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

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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

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Polytrauma

• 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.

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In order to meet the complex rehabilitative care
needs.

• The National Polytrauma Network of Care has been
  established

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VA TBI and Polytrauma System of Care
April 07 TBI Screening
March 07 72 Polytrauma Support Clinic Teams, 60
Polytrauma Points of Contact
July 06 Polytrauma Telehealth Network
December 05 21 Polytrauma Network Sites
February 05 Four Polytrauma Rehabilitation
Centers
1992 VHA TBI Lead Centers Selected
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Components of the National Polytrauma 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)

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Care 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

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Components of the VISN 19 Polytrauma Network of
Care
Grand Junction VAMC Polytrauma Support Clinic Team
Salt Lake VAMC Polytrauma Support Clinic Team
VISN 19 Polytrauma Network Site VA-ECHCS/Denver
Sheridan VA Medical Center Point Of Contact
Ft. Harrison VA Medical Center Point of Contact
Cheyenne VA Medical Center Point of Contact
Community-Based Out Patient Clinics
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Characteristics of the Rocky Mountain 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

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What part is played by each component of the VISN
19 Network?
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VISN 19 Polytrauma Network SiteVA-Eastern
Colorado Health Care System-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

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VISN 19 Polytrauma Network SiteVA-Eastern
Colorado Health Care System-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)

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VISN 19 Polytrauma Support ClinicsGrand 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)

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VISN 19 Polytrauma Points of ContactCheyenne,
Sheridan, and Helena and Community Based
Outpatient 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)

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Mission StatementVISN 19 Polytrauma Network of
Care

• The 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.

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Lets look more closely at what makes up the VISN
19 Polytrauma Network Site.
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VISN 19 Polytrauma System of CareSpecialty
Treatment Teams/Programs
Inpatient Rehab Program
Audiology Program
Brain Injury Program
Acute
Hearing Loss
VISN 19 Polytrauma Network Site VA-ECHCS/Denver
Head Injuries
Spinal Cord Injury Program
Cord Injury
Pain
Pain Management
Amputations
Emotional Shock
Soft Tissue Trauma
Amputee Program
Vision Loss
Vocational Limitations
PTSD Program
Rehabilitation And Orthopedic Programs
Blind Rehabilitation Program
Compensated Work Therapy Program
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How do we connect facilities 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

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To whom have we provided 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.

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To whom have we provided 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