Effectiveness and cost-effectiveness of the Transmural Trauma Care Model (TTCM) investigated in a multicenter trial with a controlled before-and-after design: a study protocol

Objective: The organization of the rehabilitation of trauma patients in primary care is challenging, and there are currently no guidelines for an optimal treatment. A recent feasibility study showed that the implementation of the Transmural Trauma Care Model (TTCM) at a Dutch level-one trauma center was feasible, that patient outcomes were improved, and that costs were reduced. The current study aims to assess the effectiveness and cost-effectiveness of the TTCM as compared to usual care.
Methods: A multicenter trial with a controlled before-and-after design will be performed at ten hospitals in the Netherlands. First, participating hospitals will include 322 patients in the control group, receiving usual care as provided in the participating hospitals. Subsequently, the TTCM will be implemented in all participating hospitals, and hospitals will include an additional 322 patients in the intervention group. The TTCM consists of a multidisciplinary team with a trauma surgeon, a specialized, hospital-based physical therapist and an educated and trained network of primary care trauma physical therapists. The main aim of the TTCM is to improve trauma rehabilitation by an increased focus on generic and disease-specific health related-quality of life, and therefore these are the co-primary outcomes. Secondary outcomes will include pain, patient satisfaction, perceived recovery, and patient-reported physical functioning. For the economic evaluation, societal and healthcare costs will be measured. Measurements will take place at baseline and after 6 weeks, 3, 6, and 9 months. Analyses will be based on the intention-to-treat principle. Missing data will be handled using longitudinal data analyses in the effect analyses and by multiple imputation in the economic evaluation.
Conclusion: This research will give insight into the effectiveness and cost-effectiveness of the Transmural Trauma Care Model (TTCM) in a multicenter trial.

We hypothesize that the TTCM improves generic and disease-specific HR-QOL and that it is cost-effective compared with usual care from both the healthcare and societal perspective.

baseline, 6 weeks, 3 months, 6 months, and 9 months

TTCM: In the TTCM, a multidisciplinary team consisting of a trauma surgeon and a specialized, hospital-based physical therapist will examine patients during their first outpatient consultations and will coordinate their entire rehabilitation process. The TTCM consists of four main elements: 1) Intake and follow-up consultations by a multidisciplinary team at the outpatient clinic, 2) Coordination and individual goal setting, 3) an educated and trained network of primary care trauma physical therapists, and 4) secure e-mail communication between hospital-based physical therapists and network physical therapists