I think, in terms of the quality of care and the consistency of care, it remains quite variable
throughout the United States.
I think that there are communities and
areas that have focused
heavily on this and invested resources in it
and committed to following,
for example, the American College of Surgeons
Committee on Trauma Guidelines
and submitted themselves
to site surveys by the Committee on Trauma.
I think that the quality of care at those centers
has been shown to be
much better than the quality of care at
other locations that have decided not to commit to that
or commit the resources necessary for that.
So it depends on the area of the United States.
Obviously, I'm not going to talk about what areas those are,
but it does.
And it is, unfortunately, still not consistent.
I think that for brain injury in particular,
more than any hypothermia treatment
or any specific treatment, per se,
the key is consistent, high-level
care that is
based on the best available
studies and the best available guidance.
And we have a pretty good idea of what that care is right now.
A number of groups, most especially the
Brain Trauma Foundation several years ago,
have spent a great deal of time and effort to
sort out what is the
optimal care for a brain injured patient
and what's not so optimal care.
[What are signs of high-quality rehabilitation programs?]
They start with an inpatient program with
physiatrists or physical medicine rehabilitation specialists
coordinating the rehab who are trained
in head injury rehab,
know what they're doing.
Those who are skilled and those who are dedicated.
It's an inpatient program, at least for 3, 4, 5 months, ideally,
and then aggressive outpatient therapy with frequent
and just a devoted team.
But it's expensive.
It costs money, and unfortunately
most insurance plans don't cover that
sort of extensive rehab.
Typically, what you see is that they will expect,
if not weekly, certainly
monthly, measurable changes,
and often change is according to the Ranchos Los Amigos scale.
Well, the Ranchos Los Amigos scale
of functionality is a very, very crude scale.
It's only an 8-point scale.
To improve one number on that scale
can mean a massive improvement
that's completely unrealistic over
the course of a week or a month.
But as you can imagine,
insurance companies will want to glom on to that and say,
"Well, we expect that much change or we won't pay for it."
Show transcript | Print transcript
Good care costs money and is predicated on the commitment to standard guidelines. Unfortunately, it varies greatly across the country.
Produced by Noel Gunther and Brian King, BrainLine.
Donald Marion, MD, MSc is director of Clinical Affairs, The Defense and Veterans Brain Injury Center, and contractor with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He is an academic neurosurgeon who has focused on the clinical pathophysiology and treatment of traumatic brain injury for more than 25 years.
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