The Brain Injury Clinic: Building a multidisciplinary clinic that utilizes technology to optimize patient outcomes

From the 2023 HVPA National Conference

Allison Nogi DPT (Johns Hopkins Hospital), Daniel Krasna MD, Brittaney Colebank MOT, OTR/L, Hannah Smith PT

Background:
Patients with brain injury typically have rehabilitation needs that require multiple providers in different specialties including physicians, physical and occupational therapists and speech language pathologists. To address this need, we created a multidisciplinary clinic to allow collaborative evaluation and management of these patients. To adjust to the unique patient characteristics, this clinic allows for in-person, virtual, or a combination of both visit types, to personalize care and optimize rehabilitation. Individuals after brain injury require support, clear expectations of a program, and concrete rehabilitation goals. The goal of the Johns Hopkins Brain Injury Program is to create multiple avenues for patients with brain injuries to receive evidence based and high quality care throughout their rehabilitation journey and life.

Objective:
Virtual visits and remote monitoring can facilitate successful rehabilitation by increasing access to specialists and allowing specialists to witness the home environment of the brain injured patient. After initial success during a pilot clinic period, the clinic increased access for brain injury patients by providing multiple evaluation and treatment days, based on the suspected level of injury. This presentation demonstrates the role for virtual technologies in the rehabilitation of patients with brain injury. In addition, we will demonstrate how to build a multidisciplinary clinic, serving a large population of patients with brain injury.

Methods:
To increase sustainability of this clinic, a decision algorithm was created for a clinic coordinator to appropriately triage brain injury patients and optimize healthcare resources. Additionally, patients within this program are provided support by outlining a clear schedule of appointments, including standardized follow-ups to reduce patient drop-out.

In order to provide services to more patients, we worked to reduce barriers to remote visits such as regulated spaces and state licensures

Results:
Our program demonstrates success for integrating multidisciplinary care through both in-person and virtual care. Collaborative care for individuals with complex cases may reduce unnecessary referrals, testing, and ultimately promote faster recovery and return to function. As specialists for brain injury are limited, this clinic model provides a mechanism for individuals to access multiple specialists that are needed for their care on the same day and provides the team specialized time to discuss each patient–catering and individualizing rehabilitation plans and goals.

Conclusions:
Traumatic brain injury can cause a multitude of symptoms for patients which sometimes requires the intervention of a diverse team. Evaluation by a multidisciplinary team may improve engagement with the patient and lead to improved outcomes. A well designed clinic structure and algorithm allows for the correct team member selection and identification of patients who could benefit from virtual therapies. Virtual therapies can reduce the burden on patients and increase engagement and relevance.

Clinical Implications:
Patients felt the access to multiple providers and hearing a comprehensive evaluation and plan all within one day was much more manageable than multiple separate appointments on different days.

Collaborative care and particularly our decision algorithm reduce unnecessary referrals, testing, and time to treatment and recovery.

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