title: Evaluation of a new Transmural Trauma Care Model (TTCM) for the rehabilitation of trauma patients: a study protocol.
abstract: Improved organization of trauma care in the acute phase has reduced mortality of trauma patients. However, there has been limited attention for the optimal organization of post-clinical rehabilitation of trauma patients. Therefore we developed a Transmural Trauma Care Model (TTCM). This TTCM consists of four equally important components: 1) intake and follow up consultations by a multidisciplinary team consisting of trauma surgeon and hospital based trauma physical therapist, 2) coordination and individual goal setting for each patient by this team, 3) primary care physical therapy by specialized physical therapists organized in a network and 4) E-health support for transmural communication and treatment according to protocols. The aim of the current study is to assess the cost-effectiveness of the TTCM.
  
  
  
  Patients will be recruited from the outpatient clinic for trauma patients of the VU University Medical Center (VUmc) if they have at least one fracture and were discharged home. A controlled-before-and-after study design will be used to compare the TTCM with regular care. Measurements will take place after the first outpatient clinical visit and after 3, 6 and 9 months. Prior to the implementation of the TTCM, 200 patients (50 patients per time point) will be included in the control group. After implementation 100 patients will be included in the intervention group and prospectively followed. Between-group comparisons will be made separately for each time point. In addition, the recovery pattern of patients in the intervention group will be studied using longitudinal data analysis methods. Effectiveness will be evaluated in terms of health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Cost-effectiveness will be assessed from a societal perspective, meaning that all costs related to the TTCM will be taken into account including intervention, health care, absenteeism, presenteeism and unpaid productivity. Additionally, a process evaluation will be performed to explore the extent to which the TTCM was implemented as intended, and to identify possible facilitators and barriers associated with its implementation.
  
  
  
  This planned research will give insight into the feasibility of the TTCM model in clinical practice and will give a first indication of the cost-effectiveness of the TTCM and help us to further develop post-clinical trauma care.
  
  
  
  Trial registration number: NTR5474 . The Netherlands National Trial Register (NTR). Registered 12 October 2015.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center and the EMGO institute for Health and Care Research, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands. s.wiertsema@vumc.nl.
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Wiertsema
authors.affiliation: Department of Health Sciences, VU University and the EMGO institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: van Dongen
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Edwin
authors.initials: E
authors.lastname: Geleijn
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Maaike
authors.initials: M
authors.lastname: Schothorst
authors.affiliation: Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: de Groot
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center and Department of Health Sciences VU University and the EMGO institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Raymond W J G
authors.initials: RW
authors.lastname: Ostelo
mesh_terms: D000553:Ambulatory Care; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009426:Netherlands; D010351:Patient Discharge; D017060:Patient Satisfaction; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics* / Q000458:organization & administration*; D012107:Research Design; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000534:rehabilitation*
keywords: Cost-effectiveness; Fractures; Rehabilitation; Transmural care; Trauma