VA Office of Research and Development
This pilot implementation trial will evaluate the Sleep Disorder Management Assistance for Providers and Patients (Sleep MAPP) Care Pathway in one Veterans Health Administration Polytrauma/TBI System of Care clinic. The care pathway combines a provider-facing decision-support tool that supports pre-visit administration and documentation of the Insomnia Severity Index with training and implementation support for clinic providers to deliver Brief Behavioral Therapy for Insomnia. The study will assess the feasibility and acceptability of the care pathway; describe changes in guideline-concordant insomnia screening and behavioral treatment; and describe preliminary changes in insomnia symptoms, neurobehavioral symptoms, and participation in social roles among Veterans with mild traumatic brain injury who receive Brief Behavioral Therapy for Insomnia. Up to 30 clinic providers or staff and 50 Veterans will be invited to complete research surveys and interviews. Implementation and clinical outcomes will be obtained from routinely collected clinical data.
The Sleep MAPP Care Pathway is a multicomponent implementation strategy designed to improve delivery of guideline-concordant insomnia screening and treatment in the Veterans Health Administration Polytrauma/TBI System of Care. The first component is the Sleep MAPP decision-support tool. The tool uses existing electronic health record and scheduling information to identify Veterans with upcoming appointments who may be appropriate for insomnia symptom screening, supports electronic administration and documentation of the Insomnia Severity Index, displays screening status and results to the cli…
Inclusion Criteria: Aim 1 Provider participants (study procedures aimed at understanding feasibility and acceptability) \- Multidisciplinary member of the Polytrauma Network Site who is involved in implementation of the Sleep MAPP Care Pathway (e.g., program leadership, referring clinicians, and clinicians eligible for Brief Behavioral Therapy for Insomnia training). Aim 1 Veteran participants (study procedures aimed at understanding feasibility and acceptability) * Clinician-confirmed mild traumatic brain injury documented in the Comprehensive TBI Evaluation Database. * Received the Insom…
The Sleep MAPP Care Pathway includes four components: (1) the Sleep MAPP clinical decision-support tool, which identifies Veterans who may benefit from insomnia screening and provides clinicians with screening results and care prompts; (2) insomnia screening using the Insomnia Severity Index (ISI); (3) training PNS rehabilitation clinicians to deliver Brief Behavioral Treatment for Insomnia (BBTI); and (4) delivery of BBTI to clinically appropriate Veterans as part of routine care. BBTI is a brief, evidence-based behavioral treatment for insomnia that includes sleep education, stimulus control, sleep restriction, and strategies to support adherence and maintenance of treatment gains.