Early Effects of the Trauma Collaborative Care Intervention: Results From a Prospective Multicenter Cluster Clinical Trial.

OBJECTIVES To evaluate the impact of the Trauma Collaborative Care (TCC) program's early intervention components on 6-week outcomes. TCC was developed to improve psychosocial sequelae of orthopaedic trauma and includes the Trauma Survivors Network and additional collaborative care services. DESIGN Prospective, multicenter, cluster clinical trial. SETTING Level I Trauma Centers. PATIENTS Individuals with high-energy orthopaedic injuries requiring surgery and hospital admission: 413 patients at 6 trauma centers implementing the TCC program and 374 patients at 6 trauma centers receiving usual care. INTERVENTION TCC early intervention: patient education, peer visits, and coaching calls. MAIN OUTCOME MEASUREMENTS Pain rating scale, Patient Health Questionnaire-9 depression, Post-Traumatic Stress Disorder Checklist, and self-efficacy for return to work and managing finances. For each outcome, a hybrid Bayesian statistical procedure, accounting for clustering within sites and differences in baseline characteristics between sites, was used to estimate the intention-to-treat (ITT) effect and the effect under full receipt of early intervention components. RESULTS Sites varied substantially in utilization of intervention components. The posterior estimates of the ITT (full receipt) effect favor TCC for 4 (5) of the 5 endpoints. The posterior probabilities of a favorable (ITT; full receipt) TCC effect were as follows: depression (89%-93%), pain (84%-74%), post-traumatic stress disorder (68%-68%), self-efficacy for return to work (74%-76%), and self-efficacy for managing finances (47%-61%). CONCLUSIONS Results suggest TCC may have a small positive effect on early outcomes, but use of the services was highly variable among sites. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.