spinal cord injury model system at nrh: 2006-2011
In 2006, the National Institute on Disability and Rehabilitation Research (NIDRR) selected the Spinal Cord Injury Program at National Rehabilitation Hospital (NRH) to receive the Model System designation. NRH joints the ranks of just a handful of SCI programs nationwide (14 for the 5-year period beginning in Fall, 2006) receiving this honor. Under the direction of Suzanne Groah, MD MSPH, the National Capital Spinal Cord Injury Model System (NCSCIMS) provides services to the SCI community not only in metropolitan DC but on a national level as well through collaborative efforts with other NIDRR SCI Model Systems established across the country. View NCSCIMS slide show!
By focusing on the frequent and costly complication of pressure ulcers (PUs), the new Model System builds on two unique strengths NRH possesses: an existing RRTC (Rehabilitation Research and Training Center) on SCI that focuses on reduction of secondary conditions, and the population of Washington DC, which is predominantly composed of underserved individuals. By virtue of its close proximity to national elected officials, policymakers, and news media, the NCSCIMS at NRH promises be a particularly compelling advocate for the needs of persons with SCI.
NRH data indicate that 46-52 people with newly-acquired traumatic SCI are treated each year while twice that number are treated for spinal cord disease (SCD). Juxtaposed against the grandeur of the nation’s capital is an underlying community that is predominantly underserved, poor, and with low levels of literacy. Superimpose a new disability due to SCI, disproportionately of a violent cause, and many with SCI treated at NRH are clearly underserved. NRH is an ideal site for the NCSCIMS because it is the primary provider of SCI services within the DC metropolitan area, because it is the sole Washington metropolitan rehabilitation provider for MedStar Health, and because it is adjacent to MedSTAR, the largest trauma center in the area and the focus of a Federal effort to build a model response system to emergencies such as terrorism.
The academic and research infrastructure supporting the NCSCIMS is also strong; NRH is the site of the Georgetown University Department of Rehabilitation Medicine and a highly competitive PMR residency program. The NRH Research Division hosts investigators and their trainees from Georgetown, Catholic University, MedStar Research Institute, George Washington University, University of Maryland, and the intramural program of NINDS.
Over the next five years, the NCSCIMS will continue to build on an already strong SCI system of care and carry out two site-specific and two national, collaborative research projects. Our first home-based research project is led by Gerben DeJong, PhD, who also serves as the director of the new Center for Post-Acute Studies at NRH. It is termed a “Practice-Based Evidence” (PBE) project specifically focused on PU prevention for all individuals with SCI during the acute and rehabilitative phases of care (to evolve to the community in later phases). The PBE approach allows a detailed examination of the effects of methods and therapies utilized in rehabilitation to prevent PUs. These therapies are often conceived in evidence-based medicine, but in reality may not be well-matched to the broader population with SCI. In this project we will use a PBE approach to add to evidence-based practice while addressing PUs, an absolutely critical secondary complication for individuals with SCI.
Our second home-based research project is an SCI “Navigator” demonstration project that combines elements of our established program in Peer Mentoring and the concept of Patient Navigation to decrease the occurrence of PUs once the individual has returned to the community. In this project an SCI Navigator in trained to assist people with newly-acquired SCI in the transition from inpatient rehabilitation to the community, within the framework of what can, at times, be a dysfunctional healthcare system. This innovative project, led by Alex Libin, PhD and Inger Ljungberg, MPH, directly addresses the needs of the underserved, and ensures participation of individuals with disabilities in the development of interventions.
A new process known as Knowledge Translation (KT) works to assure the usefulness of the products of both our research and clinical system of care to the SCI individuals we serve. Techniques of KT integrate research with clinical activities and continually redirect focus towards providing real relief to the problem of PUs throughout the continuum of care and lifetime of the individual with SCI. Manon Lauderdale, MSE PMP, coordinates the KT program in the new Model System.