BeHEALTHY: Developing a Self-Directed Model of Care to Maximize Brain Injury Outcomes

By Flora Hammond, MD, Professor and Chair, Indiana University School of Medicine, BeHEALTHY Principal Investigator

There are lots of resources dedicated to helping people survive an injury, but then people are really left to navigate the aftermath on their own. The BeHEALTHY project is about redefining the care approaches and resources available for people over the years after brain injury. There are chronic disease models that have been in use for the past couple of decades for other diseases like diabetes, congestive heart failure, asthma, substance abuse and more. These models can teach people how to better self-manage as well as help with community resources. We don’t have a model like that for brain injury.

Many people with brain injury can struggle with long-term effects, such as difficulty with weight gain, problem-solving skills, and finding and keeping jobs. Developing a model that focuses on healthy living in a variety of areas can help with those challenges, as shown in models for other diseases. The BeHEALTHY team will examine past research on these other models to study what worked well and what didn’t and determine what may work best for those with TBI. Then the team will create a model for those with TBI and conduct feasibility studies to test out the method they develop.

Researchers across the Traumatic Brain Injury Model Systems (led by myself and John Corrigan, PhD, at the Ohio State University) are developing a new model of care (BeHEALTHY) to help those who experience a brain injury recover and better manage challenges that result from their injury. This work is being funded through a $2.5 million federal grant from the United States Department of Health and Human Services and the National Institute on Disability, Independent Living, and Rehabilitation Research to develop this chronic disease model. The project will take about five years.

The first year focused on reviewing research on models that exist for other chronic diseases. With this information in hand, in the second year, the team proposed a comprehensive, person-centered model of care. The proposed model uses an integrated care approach which incorporates the community (public policy, resources, supportive environment) as well as the health care system (delivery systems, decision support, clinical information systems, and supported self-management). In the third year, the investigators developed 13 projects to be able to plan and refine the model and develop needed materials. Now, in the fourth year, these projects are currently under way. Examples of these projects include developing an intake process and forms, creating a case definition for chronic brain injury, assessing environmental needs and impacts, determining abilities important for self-management, examining the applicability of available self-management treatments for persons with brain injury, assessing the usability of electronic applications for self-monitoring, assessing current primary care and brain injury physician usage patterns, identifying tools to assess social determinants of health, examining resource use and access in rural versus urban settings, collecting and analyzing assessment tools used by resource facilitation programs, and partnering with a managed care organization to analyze brain injury resource utilization and costs.

BeHEALTHY is aimed at reshaping how people with TBI can get better outcomes by looking at both changes in the health system and in the community. This is based on incorporating the evidence-based principles of brain health with established science driving optimal brain injury care.

The core principles of the proposed model include: 1) prepared, proactive providers; 2) informed, activated, & supported people with TBI and their caregivers; 3) activated communities and prepared proactive community partners; and 4) person-centered and culturally humble approach.

The 9 core components of BeHEALTHY include:

1. Educate and support
2. 2Identify and treat hazards
3. Reduce potential iatrogenic harm
4. Prescribe appropriate treatments
5. Facilitate social and intellectual engagement
6. Encourage healthy brain behaviors
7. Review for comorbid health conditions and medications
8. Facilitate communication
9. Evaluate community barriers and opportunities

More information about the BeHEALTHY project is available at https://medicine.iu.edu/physiatry/research/behealthy.