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NICoE & ISC Network maintain TBI care during COVID-19

Image of United States map with locations noted. Click to open a larger version of the image. This map shows the location of the National Intrepid Center of Excellence (NICoE) and Intrepid Spirit Centers (ISC) that span across the country to create the NICoE and ISC Network. (Image from NICoE Communications.)

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In the first six months of the COVID-19 pandemic, more than 8,300 patients sustained or were diagnosed with their first traumatic brain injury (TBI) across the Department of Defense.

The National Intrepid Center of Excellence (NICoE) and Intrepid Spirit Centers (ISC) across the country make up the NICoE and ISC Network—a group dedicated to TBI care, research, and education. Though the COVID-19 pandemic disrupted normal operations, the Network synchronized enterprise capabilities to coordinate TBI care.

Coordinating Patient Care across the Network

Within two weeks of the pandemic’s official declaration, ISC directors began strategizing telehealth transitions, sharing lessons learned, and brainstorming alternatives to improve readiness, while still adhering to Centers for Disease Control and Prevention guidelines to ensure patient and staff safety.

The Network leveraged their geographic distribution to help each other quickly adapt to changing times. Staff exchanged ideas on personal protective equipment and clinical service offerings to remain prepared.

Staff members formed specialty working groups to share best practices with others across the Network who work in their field. Current TBI working groups include health systems specialists, case managers, physical therapy professionals, speech language pathology professionals, nutritionists and dieticians, and neuropsychologists.

The NICoE’s TBI Portal is the Defense Health Agency (DHA) enterprise application within CarePoint that provides a consolidated view of TBI patient data. During the pandemic, the ISC Network and several TBI clinics used the TBI Portal and other enterprise capabilities to track in real-time the clinical services received by TBI patients and track outcome measures regardless of treatment mode and location.

Training efforts crossed state and international borders. For instance, providers at ISC Fort Hood in Texas and ISC Fort Carson in Colorado received training for virtual health platforms from the TBI clinic at the Landstuhl Regional Medical Center in Germany. Overall, the Network supported 30 virtual health training sessions during the first 90 days of the pandemic to transition many clinical services to a virtual environment.

ISC Fort Belvoir in Virginia transitioned from offering no virtual health clinical encounters to offering 100% fully capable virtual health operations within one week for all clinical providers. Since March, there has been a 40% increase in virtual health appointments across the Network.

Patient Outcomes

Many patients have expressed gratitude for the NICoE and ISCs continuing their clinical services offerings throughout the pandemic. One patient at the NICoE who suffers from TBI-related migraines appreciates not having to drive to the NICoE, located at Walter Reed National Military Medical Center in Bethesda, Maryland. The NICoE staff has helped him control the light and sound at home during appointments, which has improved his concentration and allowed him to take in information more effectively.

Another TBI patient at ISC Fort Belvoir wrote, “[The FBCH] Intrepid [Spirit Center] employs the best physicians and front desk staff in the military. They are professional, knowledgeable, and innovative; their teamwork sets them apart from every other hospital I’ve ever visited … They’ve been extremely responsive and proactive despite the ongoing COVID in-clinic restrictions.”

“Our local response to COVID-19 was significantly enhanced due to the connective tissue, collective brain power, and institutional experience shared by the NICoE and ISC Network leadership,” according to Dr. Scott Engel, ISC Fort Hood director. “The Network's ongoing partnership and communication allowed us to leverage the TBI Portal, share and disseminate lessons learned throughout the TBI Enterprise, and adjust and adapt to the changing day-to-day conditions on the ground so that our patients got the care they needed for mission readiness.”

Looking Forward

As the Network expands its enterprise-wide capabilities, it aims to provide better tracking and patient outcomes and improve standardized metrics used across the Military Health System. It also plans to deepen its partnership with the Department of Veterans Affairs to better provide continuing care as service members transition out of the military.

Proper TBI care can improve force readiness by allowing service members to safely resume their active-duty roles and lead healthier lives, according to Eddy Bueno, deputy director of the NICoE.

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