The Transmural Trauma Care Model (TTCM)

The TTCM (see image below) consists of four components, all of which are linked to one another, i.e.:

1. A multidisciplinary team at the outpatient clinic for trauma patients;
2. Coordination and individual functional goal setting for each patient by the multidisciplinary hospital-based team;
3. A network of specialized primary care physiotherapists; and
4. Secured email traffic between the hospital-based physiotherapist and the primary care network physiotherapist.

We examined the TTCM’s effectiveness and cost-effectiveness in 285 trauma patients with at least one fracture in a controlled-before-and-after study in terms of HR-QOL, functional outcome, pain and patient satisfaction. Preliminary evidence was provided that the TTCM improves patient related outcome measures, such as disease-specific HR-QOL, functional status, and patient satisfaction among mild, moderate and severe trauma patients with at least one fracture compared with regular care. For example, the mean difference for functional status at 9 months was nearly 21 points on a 100-points scale, favoring the TTCM group. Furthermore, patients in the intervention group suffered from statistically significantly less pain at 6 and 9 months than their control group counterparts.

Additionally, we performed a process evaluation, which showed that the TTCM was largely implemented as intended. However, various facilitators and barriers were identified that need to be considered when implementing the TTCM broadly. Examples of such facilitators and barriers are the “shared decision-making process at the outpatient clinic” and an “increased level of knowledge and skills” (facilitators) and the “absence of reimbursement for the hospital-based physical therapists at the outpatient clinic” (barrier for implementation).