1. National Polytrauma System of Care and VISN 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

2. 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

3. VHA PM&RS Web Resource Polytrauma System of Care Webpage http://www.polytrauma.va.gov/

4. 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

5. 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.

6. In order to meet the complex rehabilitative care needs…. The National Polytrauma Network of Care has been established

7. February 05: Four Polytrauma Rehabilitation Centers December 05: 21 Polytrauma Network Sites VA TBI and Polytrauma System 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

8. 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)

10. 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

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

12. 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

14. What part is played by each component of the VISN 19 Network?

15. VISN 19 Polytrauma Network Site VA-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

16. VISN 19 Polytrauma Network Site VA-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)

17. VISN 19 Polytrauma Support Clinics Grand 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)

18. VISN 19 Polytrauma Points of Contact Cheyenne, 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)

19. Mission Statement VISN 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.

20. Let’s look more closely at what makes up the VISN 19 Polytrauma Network Site….

21. VISN 19 Polytrauma System of Care Specialty Treatment Teams/Programs VISN 19 Polytrauma Network Site VA-ECHCS/Denver Brain Injury Program Pain Management PTSD Program Rehabilitation And Orthopedic Programs Audiology Program Amputee Program Head Injuries Pain Emotional Shock Soft Tissue Trauma Amputations Hearing Loss Blind Rehabilitation Program Vision Loss Spinal Cord Injury Program Cord Injury Compensated Work Therapy Program Vocational Limitations Inpatient Rehab Program Acute

22. 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

23. 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.

24. 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