Read Suggested Topics for Research | AHRQ Effective Health Care Program

Topic Suggestion Description

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.: What is the comparative effectiveness and harms of treatments for traumatic brain injury? Preliminary Key Questions 1. What is the comparative effectiveness of the treatments for TBI for grades I-IV? 2. For patients, what are the potential harms of TBI treatment interventions? 3. Are there subgroups of people with TBI for whom interventions are more effective or more harmful than for other subgroups of patients? 4. Are there particular forms of therapy, including number of treatments, length of treatments, frequency of treatments, or total duration of treatments that are most effective?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.): yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:: Physical, behavioral, speech, occupational, and/or cognitive rehabilitation therapies, neurorehabilitation, medication or combinations of these interventions compared to standard treatment or other treatments or no treatment.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.): Children, adolescents, and adults, six months post initial injury, with sustained cognitive, physical, and/or psychological impairments from a TBI

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.): -Severity of TBI -Race -Gender -Concomitant psychological diagnoses and/or medical diagnoses

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.): Change in scores on standardized neuropsychological tests measuring areas of cognitive function, patient oriented outcomes such as functional improvements in activities of daily living (ADLs), improvement in employment status, quality of life, hospitalizations/ER visits

Describe any health-related risks, side effects, or harms that you are concerned about.

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?: yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

AHRQ Priority Populations

Low income groups
Minority groups
Women
Children
Elderly
Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

Describe why this topic is important.: State legislatures are considering potential insurance mandates for coverage of TBI treatment. The nominators are interested in identifying the level of evidence (even if there is no evidence) available for interventions and outcomes. The documentation of the lack of evidence is considered key in designing policy.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.): States are faced with developing policies with large uncertainty about the appropriate approach and effectiveness for some of these interventions and they are costly. The states are considering a practice guideline if this can be developed and supported by the evidence base.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.): yes
If yes, please explain:: Policy makers are faced with making a decision regarding appropriate coverage. Evidence regarding effectiveness and harms of treatments, or information regarding the lack of evidence for treatment would support this work. Uncertainty for clinicians in determining most appropriate/effective therapy.

How will an answer to your research question be used or help inform decisions for you or your group?: The information would be used by state legislatures and policy makers to develop policy regarding TBI coverage. In addition, the results would be disseminated by states to clinicians to help inform better practice.

Describe the timeframe in which an answer to your question is needed.: 1 year

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.: Answers to these questions would help determine a more effective and efficient approach to the care of individuals disabled or impacted by TBI.

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care program