Toward National Trauma Care Practice Change for PTSD and Comorbidity: Lessons Learned from the TSOS Pragmatic Trial
Douglas Zatzick, MD, Professor of Psychiatry and Attending Psychiatrist at Harborview Level I Trauma Center at the University of Washington School of Medicine
Gregory J. Jurkovich, MD, Professor and Vice Chair, Department of Surgery, at the University of California, Davis
Trauma care; Posttraumatic stress disorder; PTSD; Multiple chronic conditions; National guidelines; A Policy-Relevant U.S. Trauma Care System Pragmatic Trial for PTSD and Comorbidity; TSOS; Implementation
TSOS is the Trauma Survivors Outcomes and Support pragmatic clinical trial, a demonstration project of the NIH HCS Collaboratory.
TSOS is a hybrid effectiveness–implementation trial that uses a stepped-wedge intervention rollout. The intervention focuses on trauma center treatment of posttraumatic stress disorder (PTSD) and comorbid conditions at 25 U.S. level I trauma center sites.
The TSOS study team is advocating for a greater focus on preventable deaths, such as suicide and unintentional overdoses, due to mental health or substance use conditions. The aim is for TSOS results to be translated into trauma care policy and thus effect practice change at U.S. trauma centers.
The results of TSOS will be reviewed by the American College of Surgeons’ Committee on Trauma, which produces guidance and resources for the optimal care of injured patients.
The trial’s collaborative publication model intends to advance adoption and practice change for PTSD and comorbidity at U.S. level I and II trauma centers.
Traditionally, there has been a long lag time between study results and new policy recommendations from professional societies. Ideally, policy guidance should be reviewed every year and fine-tuned in light of new study data.
What amount of evidence (number of trials, body of evidence) is sufficient to enact new guidance? What does it take to get clinicians to adopt and change their practice?
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@PCTGrandRounds, @Collaboratory1, @PCORnetwork