Objective:

To improve patient and care team experience in a concussion/traumatic brain injury (TBI) clinic, and to evolve TBI diagnosis and care models using a point-of-care precision medicine dashboard (BRIDGE). 

Background:

TBI symptom manifestations and recovery trajectories are heterogenous. Frontline ambulatory providers—including neurologists, primary care providers, neurosurgeons, rehabilitation therapists, and others—must navigate a large volume of injury-related information in the electronic health record (EHR) to provide tailored treatment aligned with evolving injury characterization and management frameworks. Patients must also digest this information to understand their recovery and treatment plans. BRIDGE is a technologically scalable digital health tool integrated within the EHR that can be adapted to specific clinical contexts to improve care delivery and clinical research.

Design/Methods:

A human-centered design framework was utilized for iterative design, refinement and implementation of TBI-BRIDGE. This included 5 phases: 1) study team knowledge sharing, 2) TBI-BRIDGE mock-up development, 3) qualitative evaluations of mock-ups, 4) TBI-BRIDGE development, and 5) TBI-BRIDGE implementation within clinics. 

Results:

During stages 1-3, 19 patients with TBI and 11 clinical team members (CTM) within local recovery clinics with representation from neurology, neuropsychology, occupational therapy, physical therapy, patient navigation, speech-language pathology, and physician trainees (neurology, neurosurgery), provided feedback. Regarding data visualization, patients provided more positive ratings toward TBI-BRIDGE mock-ups (17 positive responses, 1 negative response, 1 no response) compared to EHR visualizations (7 positive responses, 7 negative responses, 1 neutral response, 4 no response). Enhancement suggestions included longitudinal visualization of recovery progress (both groups) and injury features (CTM). Perceived utility included efficiency of visualizing injury, recovery, and plan information (both groups). 

Conclusions:

All stakeholders, including nearly all patients surveyed, expressed greater enthusiasm for TBI-BRIDGE than for existing EHR data visualization tools for the care of TBI. TBI-BRIDGE can augment clinical encounters by streamlining access to actionable information to support data-driven, personalized care.