Based on the Individual and Family Self-Management Theory, BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) is a culturally-tailored, patient- and family-centered, transitional care intervention for adults with traumatic brain injury (TBI) discharged home from acute hospital care and families. The goal of the intervention is to improve patients’ quality of life (change in SF-36 total score, primary outcome) by 16-weeks post-discharge, as this timeframe includes high rates of unmet patient/family needs and preventable clinical events. Thus, the purpose of this study is to examine the efficacy of BETTER (vs. usual care) among adults with TBI of various races/ethnicities who are discharged home from acute hospital care and families. 

Black and Latino adults with mild-to-severe TBI face inequities in TBI-related consequences, demonstrated by higher incidence and hospitalization rates, and worse cognitive, physical, behavioral, and emotional impairments more than 12 months post-discharge compared to Whites. Oyesanya said these impairments affect patients’ abilities to independently manage their health, wellness, and activities of daily living, resulting in dependence on family, particularly for racial/ethnic minorities. “The complexity of needs combined with the fragmentation of healthcare services creates the perfect storm for low patient quality of life, mismanaged symptoms, rehospitalizations, and increased caregiver strain,” Oyesanya said. Additionally, factors such as lack of insurance, access to care, and language barriers, some of which are social determinants of health (SDoH), aggravate these ongoing issues. 

Despite complex health needs, there are no U.S. standards for transitional care for patients with TBI. Transitional care is defined as actions in the clinical encounter designed to ensure the coordination and continuity of healthcare for patients transferring between different locations or levels of care (e.g., acute hospital care to home). In other patient groups with acute events (e.g., stroke, myocardial infarction), transitional care interventions have led to improved patient quality of life and health outcomes. Yet, few TBI transitional care interventions exist, and these existing interventions do not equitably address needs of racial/ethnic minorities. 

The prevailing racial/ethnic disparities in TBI-related outcomes and the paucity of theory-driven, evidence-based TBI transitional care interventions led Oyesanya and her team to develop BETTER. Skilled clinical interventionists who deliver BETTER will follow a manualized intervention protocol to address patient/family needs; establish goals; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills ≤16 weeks post-discharge. Findings from Oyesanya’s NIH R03 pilot study showed BETTER significantly improved patients’ physical QOL by 31.36 points (p = 0.006) and that the intervention was feasible and acceptable with younger adults with TBI and families. Oyesanya’s NIH R03 pilot study directly informed this R01 proposal.

The findings from this study will guide Oyesanya and her team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will also drive advancements in health equity among adults with TBI of various races/ethnicities and families.