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Testing a Scalable Model of Care to Improve Patients Access to Mental Health Services After Traumatic Injury

Primary Purpose

Posttraumatic Stress Disorder, Depression

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Trauma Resilience and Recovery Program
Sponsored by
Medical University of South Carolina
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Posttraumatic Stress Disorder

Eligibility Criteria

16 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • English- or Spanish-speaking patients ≥ 16 years old who are admitted to George Washington University hospital's trauma center and screen positive on the Injured Trauma Survivors Screen (which indicates risk for development of posttraumatic stress disorder and/or depression) will be included.

Exclusion Criteria:

  • Patients who have a Glasgow Coma Scale score under 13 at hospital admission, moderate to severe cognitive impairment (as measured by the Montreal Cognitive Assessment), active psychosis, or injury that prevents verbal communication (e.g., serious head or spinal cord injury) or is self-inflicted will be excluded. Patients with positive substance use screens via GWU's SBIRT protocol (~7% of the patient population) will be assessed by the clinical team with reference to severity and recency of substance use problems. We have found at MUSC that a high percentage of patients with SBIRT- positive screens are nevertheless good candidates for TRRP (>85%), but patients with serious, active substance abuse problems are likely not good candidates for TRRP and therefore will be excluded and referred to a substance use treatment center.

Sites / Locations

  • George Washington University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Trauma Resilience and Recovery Program

Enhanced Usual Care Condition

Arm Description

TRRP is a stepped model of care that delivers education at the bedside about mental health recovery after traumatic injury as well as risk assessment and brief intervention for high-risk patients (Step 1), fosters symptom monitoring and continued education (Step 2), screens for PTSD and depression 30 days post-injury (Step 3), and provides a referral and warm handoff to mental health services if needed (Step 4)

Patients in the EUC arm will be given education about mental health after traumatic injury, educational materials about mental health recovery, and local referral information to assist treatment-seeking patients in seeking care.

Outcomes

Primary Outcome Measures

Change from Baseline PTSD Checklist for DSM-5 8- item (PCL8-5) at 3-,6-, and 12-month
The PTSD Checklist for DSM-5 (Weathers et al., 2013) is a self-report measure that assesses the extent to which participants are bothered by the DSM-5 PTSD symptoms. Each symptom is rated on a scale of 0 (not at all) to 4 (extremely). Total scores are obtained by summing the scores of all items. The 8-item adaptation includes assessment of intrusive thoughts, avoidance of external reminders, negative expectations of self/ world, easily startled, emotional cue reactivity, avoidance of thoughts/emotions, loss of interest, and difficulty concentrating. The PCL8-5 has strong psychometric properties and clinical utility data similar to that of the long version.

Secondary Outcome Measures

Demographics
Patients will provide standard demographic information, such as race/ethnicity; sex; gender identity; immigration, insurance, marital, and socioeconomic status; language; educational attainment; and occupation
Injured Trauma Survivor Screen (ITSS)
Injured Trauma Survivor Screen (ITSS) is a 9-item measure used to assess risk for development of posttraumatic stress symptoms following injury. Items are rated yes=1 and no=0. If the sum of questions 1, 2, 3, 5, and 6 is equal to or greater than 2, the screen is positive for PTSD risk. If the sum of questions 3, 4, 7, 8, and 9 is equal or greater than 2, the screen is positive for depression risk.
Electronic Medical Record Data (EMR)
Data will be collected at baseline via the electronic medical record including patients' length of stay; injury severity scores; number of emergency department visits; and opioid, anti-anxiety and anti-depression medications prescribed.
The Kessler 6 (K6)
The Kessler 6 (K6) is a screening scale for nonspecific distress to discriminate cases of severe mental illness. Items are rated on a 5-point Likert scale (0-4). Total scores range from 0-24 and are calculated as the sum of all item ratings, with a total score ≥ 5 indicating moderate levels of distress and scores ≥ 13 indicating severe mental illness. This measure has been shown to have strong psychometric properties.
PROMIS Emotional and Instrumental Support
The PROMIS Emotion and Instrumental Support measure assesses perceived feelings of being cared for and valued as a person; having confidant relationships and availability of assistance with material, cognitive, or task performance. Calculate a summed score across all items. All item responses scored on a scale of 1-5 where Never = 1, Always = 5 3. Score of a 50 is the average for US population, SD of 10
The Major Experiences and Everyday Discrimination Scale
The Major Experiences and Everyday Discrimination Scales include 19 yes-or-no and frequency response category questions. The Major Experiences subscale includes 9 questions about employment, housing, and education; the Everyday Discrimination subscale includes 10 questions about interactions with other people, including courtesy, respect, and harassment. * no scoring needed at this time.
National Health Interview Survey Adult Access to Health Care and Utilization Module
This protocol includes 10 interviewer-administered questions from the National Health Interview Survey (NHIS) Adult Access to Health Care & Utilization Module designed to assess when medical care was last sought, usual place of care, frequency of getting medical care and reasons for not getting medical care.
The California Health Interview Survey (CHIS) question
The California Health Interview Survey (CHIS) question allows a binary measurement of perceived prejudice, stereotyping, and discrimination in clinical encounters and experience.
Patient Health Questionnaire-9 (PHQ-9)
The Patient Health Questionniare-9 (PHQ-9) assesses the presence and frequency of 9 core depressive symptoms. Items are rated on a 4-point Likert scale (0-3). Total scores range from 0-27 and are calculated as the sum of all item ratings, with a total score of ≥ 10 indicating clinical significance.
Acceptance of Treatment Referral and Initiation of Treatment
Patients will be asked whether they considered seeking assistance for mental health needs and whether they actually sought help. These questions will be based on semi-structured interviews administered via our needs assessment that were adapted from epidemiologic interviews conducted by our team in the aftermath of the September 11, 2001 terrorist attacks and recent natural disasters. Follow-up questions will inquire about whether patients sought help from family members, friends, chaplains, mental health professionals, or other health care professionals.
PROMIS Pain Intensity and Interference Scale
The PROMIS Pain Intensity and Interference scale assesses patients' pain and the extent to which it affects enjoyment of various activities in the past 7 days. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
Stigma Scale for Receiving Psychological Help
The Stigma Scale for Receiving Psychological Help assesses individuals' perceptions of how stigmatizing it is to receive psychological treatment. The SSRPH consists of 5 questions rated on a 3-point Likert scale. Total Score Instructions: Total score of the 5 items. No Items are reverse scored.
NIDA Quick Screen; alcohol, tobacco, prescription and illicit drug use
The NIDA Quick Screen is a validated instrument designed to assist providers in screening adults for substance use. The screen simply inquires whether a participant has used drugs (mood-altering, illegal, or prescription for nonmedical reasons), alcohol, or tobacco products within the past year and how often these substances have been used.
PROMIS Self-Efficacy
The 4-item PROMIS Self-Efficacy scale is a measure of confidence in one's ability to deal effectively with a variety of stressful situations. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
PROMIS Sleep Disturbance
The 4-item PROMIS Sleep Disturbance scale assesses perceptions of sleep quality, sleep depth, and restoration associated with sleep. Calculate a summed score access all items. All item responses scored on a scale of 1-5. Score of a 50 is the average for US population, SD of 10.
PROMIS General Life Satisfaction
The 10-item PROMIS General Life Satisfaction questionnaire measures one's perception of life experiences and whether one likes his/her life or not. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
PROMIS Global Health
The 10-item PROMIS Global Health questionnaire measures one's overall evaluation of one's physical and mental health.
Occupational Status
Consistent with Zatzick and colleagues we will ask patients about post-injury occupational status.
Job Insecurity
The Job Insecurity measure is a measurement of the perceived stability of one's current job and ability to find jobs with similar salary and benefits.
Food Insecurity
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a validated, well-established measure of the availability, accessibility, and affordability of nutritionally adequate food.
National Adverse Childhood Experiences Questions
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a validated, well-established measure of the availability, accessibility, and affordability of nutritionally adequate food.
Neighborhood Environment
The Neighborhood Environment Scale measures perceived neighborhood context and provides an estimate of cumulative exposure to adversity in childhood.

Full Information

First Posted
August 5, 2022
Last Updated
January 5, 2023
Sponsor
Medical University of South Carolina
Collaborators
George Washington University, Agency for Healthcare Research and Quality (AHRQ)
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1. Study Identification

Unique Protocol Identification Number
NCT05497115
Brief Title
Testing a Scalable Model of Care to Improve Patients Access to Mental Health Services After Traumatic Injury
Official Title
Testing a Scalable Model of Care to Improve Patients Access to Mental Health Services After Traumatic Injury
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 4, 2022 (Actual)
Primary Completion Date
August 31, 2025 (Anticipated)
Study Completion Date
August 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Medical University of South Carolina
Collaborators
George Washington University, Agency for Healthcare Research and Quality (AHRQ)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study to learn about patients' experience with the Trauma Resilience and Recovery program (TRRP) and/or the enhanced care group.
Detailed Description
In 2015, our team launched the Trauma Resilience and Recovery Program (TRRP) at the Medical University of South Carolina's Level I trauma center. TRRP is a stepped model of care that is designed to deliver education at the bedside about mental health recovery after traumatic injury as well as risk assessment and brief intervention for high-risk patients (Step 1), foster symptom self-monitoring and continued education via our automated text messaging system (Step 2), screen for PTSD and depression by chatbot or telephone 30 days post-injury (Step 3), and provide a referral and warm handoff to mental health services if needed (Step 4). The purpose of the proposed study is to examine the clinical and functional impact of TRRP over a period of 12 months. We will conduct a randomized controlled trial (RCT) with one-year follow up of TRRP vs. enhanced usual care (EUC) with 350 patients at The George Washington University (GWU) hospital, which serves a diverse population of ~2000 trauma center patients per year (15% penetrating mechanism). Trained, supervised interviewers blind to study condition will assess clinical and functional outcomes 3-, 6-, and 12-months post-baseline (Aim 1). Qualitative interviews will be conducted with ≥ 30 patients from underrepresented minority groups (i.e., African American, Latinx) as well as ≥ 20 victims of violent trauma (penetrating mechanism) to identify opportunities to strengthen the model to meet the diverse needs of these patients (Aim 2). GWU does not currently have an embedded mental health program in place, which will enable us to explore implementation determinants systematically (Aim 3).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Posttraumatic Stress Disorder, Depression

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
InvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
350 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Trauma Resilience and Recovery Program
Arm Type
Experimental
Arm Description
TRRP is a stepped model of care that delivers education at the bedside about mental health recovery after traumatic injury as well as risk assessment and brief intervention for high-risk patients (Step 1), fosters symptom monitoring and continued education (Step 2), screens for PTSD and depression 30 days post-injury (Step 3), and provides a referral and warm handoff to mental health services if needed (Step 4)
Arm Title
Enhanced Usual Care Condition
Arm Type
No Intervention
Arm Description
Patients in the EUC arm will be given education about mental health after traumatic injury, educational materials about mental health recovery, and local referral information to assist treatment-seeking patients in seeking care.
Intervention Type
Behavioral
Intervention Name(s)
Trauma Resilience and Recovery Program
Intervention Description
The Trauma Resilience and Recovery Program is a stepped model of care that is designed to deliver education at the bedside about mental health recovery after traumatic injury as well as risk assessment and brief intervention for high-risk patients (Step 1), foster symptom self-monitoring and continued education (Step 2), screen for PTSD and depression 30 days post-injury (Step 3), and provide a referral and warm handoff to mental health services if needed (Step 4).
Primary Outcome Measure Information:
Title
Change from Baseline PTSD Checklist for DSM-5 8- item (PCL8-5) at 3-,6-, and 12-month
Description
The PTSD Checklist for DSM-5 (Weathers et al., 2013) is a self-report measure that assesses the extent to which participants are bothered by the DSM-5 PTSD symptoms. Each symptom is rated on a scale of 0 (not at all) to 4 (extremely). Total scores are obtained by summing the scores of all items. The 8-item adaptation includes assessment of intrusive thoughts, avoidance of external reminders, negative expectations of self/ world, easily startled, emotional cue reactivity, avoidance of thoughts/emotions, loss of interest, and difficulty concentrating. The PCL8-5 has strong psychometric properties and clinical utility data similar to that of the long version.
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Secondary Outcome Measure Information:
Title
Demographics
Description
Patients will provide standard demographic information, such as race/ethnicity; sex; gender identity; immigration, insurance, marital, and socioeconomic status; language; educational attainment; and occupation
Time Frame
Baseline
Title
Injured Trauma Survivor Screen (ITSS)
Description
Injured Trauma Survivor Screen (ITSS) is a 9-item measure used to assess risk for development of posttraumatic stress symptoms following injury. Items are rated yes=1 and no=0. If the sum of questions 1, 2, 3, 5, and 6 is equal to or greater than 2, the screen is positive for PTSD risk. If the sum of questions 3, 4, 7, 8, and 9 is equal or greater than 2, the screen is positive for depression risk.
Time Frame
Baseline
Title
Electronic Medical Record Data (EMR)
Description
Data will be collected at baseline via the electronic medical record including patients' length of stay; injury severity scores; number of emergency department visits; and opioid, anti-anxiety and anti-depression medications prescribed.
Time Frame
Baseline
Title
The Kessler 6 (K6)
Description
The Kessler 6 (K6) is a screening scale for nonspecific distress to discriminate cases of severe mental illness. Items are rated on a 5-point Likert scale (0-4). Total scores range from 0-24 and are calculated as the sum of all item ratings, with a total score ≥ 5 indicating moderate levels of distress and scores ≥ 13 indicating severe mental illness. This measure has been shown to have strong psychometric properties.
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Title
PROMIS Emotional and Instrumental Support
Description
The PROMIS Emotion and Instrumental Support measure assesses perceived feelings of being cared for and valued as a person; having confidant relationships and availability of assistance with material, cognitive, or task performance. Calculate a summed score across all items. All item responses scored on a scale of 1-5 where Never = 1, Always = 5 3. Score of a 50 is the average for US population, SD of 10
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Title
The Major Experiences and Everyday Discrimination Scale
Description
The Major Experiences and Everyday Discrimination Scales include 19 yes-or-no and frequency response category questions. The Major Experiences subscale includes 9 questions about employment, housing, and education; the Everyday Discrimination subscale includes 10 questions about interactions with other people, including courtesy, respect, and harassment. * no scoring needed at this time.
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Title
National Health Interview Survey Adult Access to Health Care and Utilization Module
Description
This protocol includes 10 interviewer-administered questions from the National Health Interview Survey (NHIS) Adult Access to Health Care & Utilization Module designed to assess when medical care was last sought, usual place of care, frequency of getting medical care and reasons for not getting medical care.
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Title
The California Health Interview Survey (CHIS) question
Description
The California Health Interview Survey (CHIS) question allows a binary measurement of perceived prejudice, stereotyping, and discrimination in clinical encounters and experience.
Time Frame
Baseline, 3-, 6-, and 12- months post-baseline
Title
Patient Health Questionnaire-9 (PHQ-9)
Description
The Patient Health Questionniare-9 (PHQ-9) assesses the presence and frequency of 9 core depressive symptoms. Items are rated on a 4-point Likert scale (0-3). Total scores range from 0-27 and are calculated as the sum of all item ratings, with a total score of ≥ 10 indicating clinical significance.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
Acceptance of Treatment Referral and Initiation of Treatment
Description
Patients will be asked whether they considered seeking assistance for mental health needs and whether they actually sought help. These questions will be based on semi-structured interviews administered via our needs assessment that were adapted from epidemiologic interviews conducted by our team in the aftermath of the September 11, 2001 terrorist attacks and recent natural disasters. Follow-up questions will inquire about whether patients sought help from family members, friends, chaplains, mental health professionals, or other health care professionals.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
PROMIS Pain Intensity and Interference Scale
Description
The PROMIS Pain Intensity and Interference scale assesses patients' pain and the extent to which it affects enjoyment of various activities in the past 7 days. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
Stigma Scale for Receiving Psychological Help
Description
The Stigma Scale for Receiving Psychological Help assesses individuals' perceptions of how stigmatizing it is to receive psychological treatment. The SSRPH consists of 5 questions rated on a 3-point Likert scale. Total Score Instructions: Total score of the 5 items. No Items are reverse scored.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
NIDA Quick Screen; alcohol, tobacco, prescription and illicit drug use
Description
The NIDA Quick Screen is a validated instrument designed to assist providers in screening adults for substance use. The screen simply inquires whether a participant has used drugs (mood-altering, illegal, or prescription for nonmedical reasons), alcohol, or tobacco products within the past year and how often these substances have been used.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
PROMIS Self-Efficacy
Description
The 4-item PROMIS Self-Efficacy scale is a measure of confidence in one's ability to deal effectively with a variety of stressful situations. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
Time Frame
3-, 6-, and 12-months post- baseline assessment
Title
PROMIS Sleep Disturbance
Description
The 4-item PROMIS Sleep Disturbance scale assesses perceptions of sleep quality, sleep depth, and restoration associated with sleep. Calculate a summed score access all items. All item responses scored on a scale of 1-5. Score of a 50 is the average for US population, SD of 10.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
PROMIS General Life Satisfaction
Description
The 10-item PROMIS General Life Satisfaction questionnaire measures one's perception of life experiences and whether one likes his/her life or not. Calculate a summed score access all items. All item responses scored on a scale of 1-5 where Never=1, Always = 5 Score of a 50 is the average for US population, SD of 10.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
PROMIS Global Health
Description
The 10-item PROMIS Global Health questionnaire measures one's overall evaluation of one's physical and mental health.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
Occupational Status
Description
Consistent with Zatzick and colleagues we will ask patients about post-injury occupational status.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
Job Insecurity
Description
The Job Insecurity measure is a measurement of the perceived stability of one's current job and ability to find jobs with similar salary and benefits.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
Food Insecurity
Description
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a validated, well-established measure of the availability, accessibility, and affordability of nutritionally adequate food.
Time Frame
3, 6, and 12-months post- baseline assessment
Title
National Adverse Childhood Experiences Questions
Description
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a validated, well-established measure of the availability, accessibility, and affordability of nutritionally adequate food.
Time Frame
3-months post-baseline
Title
Neighborhood Environment
Description
The Neighborhood Environment Scale measures perceived neighborhood context and provides an estimate of cumulative exposure to adversity in childhood.
Time Frame
3-months post-baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: English- or Spanish-speaking patients ≥ 16 years old who are admitted to George Washington University hospital's trauma center and screen positive on the Injured Trauma Survivors Screen (which indicates risk for development of posttraumatic stress disorder and/or depression) will be included. Exclusion Criteria: Patients who have a Glasgow Coma Scale score under 13 at hospital admission, moderate to severe cognitive impairment (as measured by the Montreal Cognitive Assessment), active psychosis, or injury that prevents verbal communication (e.g., serious head or spinal cord injury) or is self-inflicted will be excluded. Patients with positive substance use screens via GWU's SBIRT protocol (~7% of the patient population) will be assessed by the clinical team with reference to severity and recency of substance use problems. We have found at MUSC that a high percentage of patients with SBIRT- positive screens are nevertheless good candidates for TRRP (>85%), but patients with serious, active substance abuse problems are likely not good candidates for TRRP and therefore will be excluded and referred to a substance use treatment center.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gabriela Becerra, BS
Phone
8439982602
Email
becerra@musc.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Hannah Espeleta, PhD
Phone
84377957658
Email
espeleta@musc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kenneth Ruggiero, PhD
Organizational Affiliation
Medical University of South Carolina
Official's Role
Principal Investigator
Facility Information:
Facility Name
George Washington University Hospital
City
Washington
State/Province
Virginia
ZIP/Postal Code
20037
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan Kartiko, MD/PhD
Phone
202-677-6219
Email
skartiko@mfa.gwu.edu
First Name & Middle Initial & Last Name & Degree
Susan Kartiko, MD/PhD
First Name & Middle Initial & Last Name & Degree
Babak Sarani, MD
First Name & Middle Initial & Last Name & Degree
Brandon A Kohrt, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
First, we will analyze the qualitative and quantitative data from our interviews and randomized controlled trial and will share these data via The National Database for Clinical Trials Related to Mental Illness. We will prepare both brief and comprehensive reports for AHRQ as we have done in prior NIH studies. We also will disseminate reports of our findings via print copy to the MUSC and GWU Public Relations office and websites. Additionally, we will prepare manuscripts for submission to research journals, such as JAMA, JAMA Surgery, JAMA Psychiatry, Am J Psychiatry, J Trauma and Acute Care Surgery, J Am College of Surgeons, Am J Public Health, and other sources that ensure broad dissemination. Additionally, as we have done previously with other federally funded grants, we will seek to present our findings to AHRQ staff and at national and international conferences.
IPD Sharing Time Frame
Data will become available Year 3 quarter 3 of the study
IPD Sharing Access Criteria
REDCap data dictionaries can be distributed for reuse at multiple institutions. A library of data dictionaries is made available for standards-based data collection forms and validated instruments. The underlying database is hosted in a secure data center at MUSC, a secure environment for data systems and servers on campus, and includes redundancy, failover capability, backups and extensive security checks.
IPD Sharing URL
http://redcap.musc.edu

Learn more about this trial

Testing a Scalable Model of Care to Improve Patients Access to Mental Health Services After Traumatic Injury

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