Using Implementation Science to Improve Health Care Access and Quality for People With Traumatic Brain Injury–Related Morbidity (I-HEAL): Protocol for a Translational Multiproject Program Award

Background: People with traumatic brain injury (TBI) morbidity (impaired cognition and behavioral regulation) and polytrauma comorbidity (depression, posttraumatic stress disorder [PTSD], chronic pain, and sleep disorders) experience health care inequities. Among Veterans and Service Members (V/SMs), TBI morbidity or polytrauma comorbidity may impact access and meaningful engagement in the high-quality health care needed to reduce poor health care outcomes. The National Academy of Science, Engineering, and Medicine Report on Accelerating Progress in TBI highlights a dearth of implementation science research in TBI that may help overcome health care access challenges. Implementation science uses a mixed methods approach to understand, implement, and examine outcomes associated with using evidence-based care in practice. Objective: The I-HEAL (Improving Health Care Access and Engagement for Veterans and Service Members with TBI Morbidity) protocol includes 4 synergistic projects with the goal of addressing key knowledge gaps that will improve access and engagement in high-quality, evidence-based health care services for V/SMs with TBI morbidity. Collectively, the 4 projects propose to: (1) adapt existing interventions to promote access and engagement in health care; (2) engage stakeholder communities to maximize uptake and translation; (3) promote research translation that informs policy and practice through knowledge translation products and deliverables targeting key partners (clinicians, V/SMs, caregivers, policymakers, and researchers); (4) facilitate research and implementation to enhance access to high-quality health care for V/SMs with TBI-related morbidity; and (5) foster the development of early/mid-career researchers in advancing implementation science research on access to care for V/SMs with TBI. Methods: Project 1 will involve the development of a nudge intervention (electronic health care reminder) for providers to engage health care proxies when interacting with cognitive disability at risk for poor health care engagement. Project 2 will involve the development of a provider toolkit of adaptations of guideline-endorsed behavioral health interventions for common polytrauma comorbidities to meet the needs of cognitively impaired individuals. Project 3 will involve the adaptation and dissemination of evidence-based team interventions for managing maladaptive behaviors after TBI. Project 4 will involve evaluation and recommendations for policy for virtual health modalities among persons with TBI and polytrauma comorbidity. Results: I-HEAL has been funded as an implementation science Focused Program Award by Congressionally Directed Medical Research Programs, and start-up activities began in October 2023. All 4 projects are currently underway with funding through September 2027. Project 1 has enrolled 48 participants, and project 3 has enrolled 34 participants through September 2025. Conclusions: TBI is associated with increased health care utilization, comorbid health conditions, and premature mortality. This study has proposed to utilize strategies from the implementation science field to help overcome barriers to physical and psychological health care in order to reduce health care disparities associated with TBI disability.