The Veterans Health Administration's Polytrauma System of Care: Rehabilitation for Today's and Tomorrow's Veterans

By Benedict, Sharon M.; Scholten, Joel | Generations, Summer 2010 | Go to article overview

The Veterans Health Administration's Polytrauma System of Care: Rehabilitation for Today's and Tomorrow's Veterans


Benedict, Sharon M., Scholten, Joel, Generations


Polytrauma injuries require intensive care management, followed by specialized inpatient and outpatient rehabilitation care to meet immediate and lifelong care needs.

One of the harshest and most highly publicized realities of the current conflicts in Iraq and Afghanistan is that service members return to the United States with traumatic brain injuries (TBI) and other significant problems. This condition is now referred to as polytrauma. Polytrauma typically causes short-term, and occasionally permanent, deficits in a variety of areas, including thinking skills, emotional functioning, and physical abilities. These deficits, in turn, may have an impact on an individual's ability to successfully reintegrate back into the community. Polytrauma injuries require intensive care management, followed by specialized inpatient and outpatient rehabilitation care to meet immediate and lifelong care needs.

In response to the unique needs of the newest cohort of veterans and service members, the Department of Veterans Affairs (VA) established a four-level polytrauma system of care (PSC) in 2005 to optimize resources and create points of access across the continuum of care. This system relied on existing strengths and experience within the VA, close collaboration with the clinicians and leadership of the Department of Defense, and strategic partnership with academic and private practice clinicians and researchers. Using the research-supported interdisciplinary team approach, integrated patient-centered care is delivered at more than 100 rehabilitation sites across the Veterans Health Administration (VHA) system. Standardized, evidence-based rehabilitation services are provided by trained clinicians with expertise in treating a patient's specific rehabilitation, medical, or mental health needs.

The VHA polytrauma system of care represents a comprehensive, integrated treatment program, based on decades of research and clinical experience in geriatric care and in the rehabilitation of individuals with acute and chronic disability. While the current prominent need is to care for the younger injured veterans returning from Operations Enduring Freedom and Iraqi Freedom, this system also serves the lifetime needs and challenges of all veterans with disabilities.

The components of the PSC include four regional polytrauma rehabilitation centers (PRC) at VA medical centers in Richmond, Virginia; Tampa; Minneapolis; and Palo Alto, California (a fifth PRC will open in 2012 in San Antonio). The PRC provides acute, comprehensive medical inpatient rehabilitation care for complex and severe polytraumatic injuries and also serves as a resource for TBI and polytrauma consultation, training, education, and research across the system of care.

For patients who require extensive periods of rehabilitation to successfully transition back to independent community living, there are polytrauma transitional rehabilitation programs (PTRP), at each PRC. These are structured residential programs focused on restoring home, community, leisure, psychosocial, and vocational skills in a controlled, therapeutic setting.

An array of outpatient rehabilitation services as well as coordination of needed services close to the patient's home is offered at other specialized rehabilitation sites within the PSC, including twenty-two veterans integrated service network polytrauma network sites, eighty-two polytrauma support clinics teams (PSCT), and forty-eight polytrauma points of contact. In order to meet the long-term needs of polytrauma patients who are unable to return home and for those who may experience decline with aging, the PSC is establishing, both within the VA and in the private community, age-appropriate assisted living and skilled nursing facility settings.

The PSC utilizes an interdisciplinary team model approach to provide care for these patients. Similar to a geriatric model, the work of these rehabilitation teams is characterized by collaboration and communication during all phases of assessment, intervention, and transition of the veteran to the next level of care. …

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