title: Improving outcomes at Level I trauma centers: an early evaluation of the Trauma Survivors Network.
abstract: BACKGROUND
  The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center.
  
  
  METHODS
  We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6 months. Outcomes evaluated at 6 months included depression, anxiety, self-efficacy, health status, and patient activation.
  
  
  RESULTS
  Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression (p = 0.05).
  
  
  CONCLUSIONS
  The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. rcastill@jhsph.edu
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Mary Zadnik
authors.initials: MZ
authors.lastname: Newell
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Carlini
authors.forename: Anna N
authors.initials: AN
authors.lastname: Bradford
authors.forename: Sara E
authors.initials: SE
authors.lastname: Heins
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wysocki
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pollak
authors.forename: Harry
authors.initials: H
authors.lastname: Teter
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Mackenzie
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D007869:Leg Injuries / Q000523:psychology / Q000628:therapy; D008297:Male; D009104:Multiple Trauma / Q000523:psychology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020377:Self Efficacy; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000523:psychology* / Q000628:therapy