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Dr. Bogner chosen to chair Behavioral Panel for a national guidelines development project commissioned by the BIAA


Dr. Jennifer Bogner has been chosen as chairperson of the behavioral panel for a national guidelines development project being commissioned by the Brain Injury Association of America. 

BACKGROUND

The Brain Injury Association of America (BIAA) recognizes that traumatic brain injury (TBI) is not an event or an outcome. For many people, it is the start of a chronic condition that can cause and accelerate disease that requires medically-necessary treatment, including rehabilitation, furnished by a multidisciplinary team of qualified and specialized clinicians at accredited programs in settings of the lowest level of acuity possible based on the needs and choices of the patient and his/her circle of support.

Individuals with TBI are routinely denied access to rehabilitation of sufficient timing, duration, scope and intensity that would allow them to achieve maximum levels of health, function and social participation. Similarly, there is an apparent preference for institutionalization in lieu of periodic treatment over the lifespan that would mitigate disease processes and help maintain quality of life. This crisis in access to care exists, in part, because commercial entities have created uninformed, inexpert, nontransparent protocols that serve as the rationale for public and private payers to engage in biased referral patterns, limit settings of care, and delay, deny or discontinue treatment altogether. The adoption and use of these proprietary protocols leads to increased re-hospitalization rates and greater levels of disability, which creates a cycle of joblessness, homelessness and dependence on public programs.

BIAA seeks to address this crisis head-on through the development and widespread distribution of clinical practice guidelines that will positively impact the allocation of healthcare resources and support patient and family decision making, with special emphasis placed on identifying appropriate settings of care and scope, duration, intensity and timing of interventions to achieve optimum outcomes. In other words, the goal of this project is to answer: How much rehabilitation should patients with moderate to severe TBI receive, in what setting, and at what time?

BIAA is contracting with the Brain Injury Research Center at the Icahn School of Medicine at Mount Sinai (ISMMS) to lead the research component of this project. BIAA staff will have a primary role in knowledge translation and dissemination efforts. Together, our objectives are to: 

  1. Identify and fully describe the continuum of care available following TBI, including U.S., international and military model descriptions and analyses; 
  2. Determine the evidence for various treatments and related rehabilitative activities, and based on that evidence and/or expert opinion and make recommendations for treatment and management in various settings; 
  3. Produce a document that supports improvements in the quality and consistency of rehabilitation treatment by eliminating practice variations as to what therapies and interventions are appropriate in what setting; and 
  4. Broadly disseminate the recommendations to payer, provider, patient and advocacy communities in an effort to increase access to and quality of care. 

The Guidelines will encompass care practices in post-acute rehabilitation settings and will be developed using generally accepted processes identified by the Institute of Medicine (IOM) and Guidelines International Network (G-I-N) as described in Appendix A of the ISMMS proposal enclosed with this letter. Recommendations will be based on a systematic review of the existing evidence using the GRADE methodology, supplemented by professional consensus developed through a Delphi process where evidence is lacking or weak. 

With input from an advisory committee comprising patients and other stakeholders, oversight of a management committee that includes representatives from BIAA and ISMMS, and support from analysts and administrative staff, the principal investigator(s) will form five panels, comprised of and led by independent experts, to carry out the project. The anticipated phases in the process will be: 

  1. Questions to guide the development of recommendations are developed and refined by panel members. 
  2. Evidence analysts search the literature, and following the GRADE methodology create draft evidence tables and draft recommendations 
  3. Where scientific evidence is altogether lacking or very weak, a modified Delphi process is used to base recommendations on expert consensus, if one can be developed 
  4. The panels formulate the final tables and recommendations 
  5. The recommendations (and the underlying evidence) are published in beta version for stakeholder comment 
    • After revision, the guidelines are published in professional and consumer versions 
    • Appropriate endorsement by professional organizations are sought 
  6. Dissemination and knowledge translation plans are implemented to make the guidelines known and used as broadly as feasible.  

The final product, which will be a set of recommendations for rehabilitation practice complete with a summary of the underlying evidence, may be submitted for journal publication and/or prepared as a free-standing publication. BIAA will translate the findings into appropriate tools for consumer use. 

 

This website has been funded with financial assistance from Grant #H133A120086 awarded by the U.S. Department of Education, National Institute on Disability Rehabilitation Research (NIDRR) to the Ohio Valley Center for Brain Injury Prevention and Rehabilitation for the current funding period of 10/01/2012 - 09/30/2017.