Care Transitions to and from the National Intrepid Center of Excellence (NICoE) for Service Members with Traumatic Brain Injury

Care Transitions to and from the National Intrepid Center of Excellence (NICoE) for Service Members with Traumatic Brain Injury

Lynsay Ayer
Coreen Farris
Carrie M. Farmer
Lily Geyer
Dionne Barnes-Proby
Gery W. Ryan
Lauren Skrabala
Deborah M. Scharf
Copyright Date: 2015
Published by: RAND Corporation
Pages: 134
https://www.jstor.org/stable/10.7249/j.ctt15sk8fw
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  • Book Info
    Care Transitions to and from the National Intrepid Center of Excellence (NICoE) for Service Members with Traumatic Brain Injury
    Book Description:

    The U.S. Department of Defense established the National Intrepid Center of Excellence (NICoE) to provide specialized services for troops suffering from traumatic brain injury (TBI). Through interviews with NICoE staff, home station providers, service members treated at the NICoE, and their families, as well as surveys and site visits, RAND evaluated interactions between the NICoE and providers referring patients and implementing treatment plans.

    eISBN: 978-0-8330-9145-1
    Subjects: Health Sciences, Psychology

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xxii)
  7. Acknowledgments
    (pp. xxiii-xxiv)
  8. Abbreviations
    (pp. xxv-xxvi)
  9. CHAPTER ONE Introduction
    (pp. 1-8)

    Between 2001 and 2011, 2.2 million U.S. service members were deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (Sayer, 2011). In an era of an all-volunteer force, the pace and demands of these conflicts have resulted in longer and more frequent deployments, and historically high levels of participation by reserve forces (Hosek, Kavanagh, and Miller, 2006; DoD, 2007). Although most service members cope well with deployment-related stresses, the wartime risks of the past decade have resulted in significant rates of physical injuries and psychological health problems among service members (Schell and Marshall, 2008).

    Improvised explosive...

  10. CHAPTER TWO Evaluation Methods
    (pp. 9-20)

    The aims of the RAND research team’s evaluation of the NICoE were to (1) describe the NICoE’s assessment and treatment services; (2) evaluate the process of referral of service members from the home station to the NICoE; (3) examine the NICoE assessment and treatment processes, including interactions with the home station during that time; and (4) evaluate the patient’s process of transitioning back to the home station and home station providers’ implementation of the NICoE’s recommendations.

    We examined these systems and processes from three perspectives:

    NICoE staff, including providers

    Home station providers

    Former NICoE patients and their families.

    In this...

  11. CHAPTER THREE History and Mission of the NICoE
    (pp. 21-26)

    The first aim of this evaluation was to provide a comprehensive description of the NICoE, including its history, mission, and assessment services. In this chapter, we address this aim by describing the history of the NICoE and, drawing on information obtained during the site visits, we describe the mission and goals of the NICoE, as well as its role within the Military Health System, both from the perspective of NICoE staff and from that of home station providers.

    In 2007, Congress passed the annual National Defense Authorization Act, which required DoD to create centers of excellence to better understand and...

  12. CHAPTER FOUR Who Is Referred to the NICoE, and How Does the Referral Process Work?
    (pp. 27-34)

    The second aim of this report was to evaluate the process of referral of service members from the home station to the NICoE. The multi-method approach described in Chapter Two provided us with the data to describe the process by which patients are referred to the NICoE for further assessment and individualized treatment. In this chapter, we explore in more detail the NICoE’s eligibility criteria, the idiosyncratic criteria used by home station providers to refer service members to the NICoE, the characteristics of service members who are referred, gaps in care at the time of referral, the steps and variability...

  13. CHAPTER FIVE NICoE Assessment and Treatment Processes
    (pp. 35-44)

    The third aim of this study was to describe the NICoE assessment and treatment processes, including interactions with the home station during that time. Our survey and site visit interviews included several questions about levels of provider, patient, and spouse satisfaction with the services provided during a patient’s stay at the NICoE and the quality of communication with NICoE staff. While opinions of the value of a stay at the NICoE, the facility’s care model, and its efforts to involve family members in patient care were positive, some providers noted gaps in the NICoE’s communication about patient progress to providers...

  14. CHAPTER SIX Transitioning from the NICoE to the Home Station
    (pp. 45-60)

    The fourth aim of this study was to evaluate the patient’s process of transitioning back to the home station and home station providers’ implementation of the NICoE recommendations. Following complete and comprehensive evaluations of all levels of patient functioning, NICoE staff develop individualized recommendations for follow-up care. The NICoE’s diagnostic findings and recommendations are described in a discharge summary intended to direct the treatment the patient will receive when he or she returns to the home station. This chapter provides a description of the NICoE’s discharge process, the discharge summary and recommendations, the process of transitioning from the NICoE back...

  15. CHAPTER SEVEN Discussion and Recommendations
    (pp. 61-70)

    The aims of this evaluation of the NICoE were to

    evaluate the process of referral of service members from the home station to the NICoE

    describe the NICoE assessment and treatment processes, including interactions with the home station during that time

    evaluate the patient’s process of transitioning back to the home station and home station providers’ implementation of the NICoE recommendations.

    This chapter summarizes the key findings from the study and describes limitations that should be considered in interpreting our results. We conclude by offering suggestions for improving care for service members who are eligible to receive services at the...

  16. APPENDIX A NICoE Site Visit Discussion Guide
    (pp. 71-76)
  17. APPENDIX B Home Station Installation Patient Discussion Guide
    (pp. 77-78)
  18. APPENDIX C Home Station Installation Spouse/Caregiver Discussion Guide
    (pp. 79-80)
  19. APPENDIX D Home Station Installation Provider Discussion Guide
    (pp. 81-84)
  20. APPENDIX E Survey Measures
    (pp. 85-102)
  21. References
    (pp. 103-106)