Strategies for Assessing Post-Hospitalization Outcomes in Trauma Survivors and their Feasibility of Implementation: A Scoping Review Protocol

ABSTRACT Background: Each year, physical trauma affects over one billion people worldwide, generating a substantial burden in terms of mortality, disability, and productivity loss. The period following hospital discharge, encompassing the transition to home as well as outpatient and community-based follow-up care, represents a critical phase in the recovery process for individuals who have experienced traumatic injuries. Yet, this phase remains poorly documented. Objective: We aim to 1) map data on assessment strategies for various outcomes among trauma survivors after hospital discharge, including the tools and administration methods used, as well as the resources required, the perceived relevance of these strategies, and the barriers and facilitators to their implementation, and 2) compare the assessment strategies and the feasibility of their implementation in terms of response rates, resource use, costs, and sustainability or continuation beyond the study period. Methods: We will conduct a scoping review using Joanna Briggs Institute methodology. We will search MEDLINE, Embase, CINAHL, Scopus, and PsycINFO for studies published since 1990 to reflect the evolution of contemporary follow-up practices, including the emergence of Patient-Reported Outcome Measures (PROMs) and digital tools. There will be no language restrictions. We will consider studies involving any trauma survivors, focusing on the evaluation of post-discharge health indicators. The period following hospital discharge, including the transition to short-term stays in rehabilitation facilities, the return home, and long-term outpatient or community-based follow-up care. Two independent reviewers will screen studies and extract data on population characteristics, assessment strategies, and feasibility dimensions. Results will be analyzed thematically and presented narratively. Counts and proportions of assessment strategies, their characteristics and associated barriers and facilitators will be presented. We also plan to conduct subgroup analyses according to clinical and social determinants and contextual factors. This protocol has been registered on the Open Science Framework. Expected Results: This review will provide an overview of current practices regarding outcome assessment strategies for trauma patients after hospital discharge. It will provide data on the resources needed and contextual factors influencing the implementation of each assessment strategy. Findings will inform the design of sustainable strategies for monitoring long-term outcomes in trauma populations. Keywords: (trauma survivors, post-discharge care, health indicators, patient-reported outcomes, feasibility.) CONTEXTE Each year, more than one billion people experience traumatic injuries worldwide [1]. Although recent advances in trauma care have significantly reduced post-trauma mortality, survivors still face a substantial ongoing burden [2]. Traumatic injuries are among the leading causes of disability [1, 3, 4], and account for the highest number of productive years of life lost [4]. The period following hospital discharge, including the transition to short-term stays in rehabilitation facilities, the return home, and long-term outpatient or community-based follow-up care, represents a critical phase in the recovery process for individuals who have experienced traumatic injuries. Yet, this continuum of care remains poorly documented.[5-8]. Trauma patients are at risk of developing long-term complications such as a decline in function, persistent pain, and reduced quality of life [9]. These risks may be exacerbated in the absence of appropriate, coordinated post-discharge support, increasing the strain on health systems and society [10]. In this context, the development of integrated, patient-centered models for follow-up outcome assessment, which are distinct from the provision of long-term-care is essential to better capture the functional, psychological, and social recovery of survivors [1, 4, 11]. Current quality of care assessment methods, such as trauma registries, typically focus on health outcomes during hospitalization or in the short term, thus neglecting patients’ long-term continuum of care [12, 13]. Furthermore, follow-up assessments rely primarily on objective health outcomes (e.g. mortality rate, readmissions) or administrative outcomes (service use, costs) [14, 15]. While these dimensions are important, they capture only a limited part of the patient’s long-term lived experience [13, 16]. In this regard, Patient-Reported Outcome Measures (PROMs) can serve as valuable complementary tools, enabling patients to assess their own health status at specific timepoints [17]. When combined with objective health outcomes, they offer a more comprehensive and nuanced view of recovery trajectories [18]. Despite their recognized value, the use of PROMs following trauma care remains inconsistent across jurisdictions. Some trauma systems, such as those in Australia [19] and the Netherlands [13] have successfully integrated longitudinal PROMs collection into routine practice. However, many other regions continue to face significant challenges that lead them to focus on isolated outcome assessment strategies rather than a comprehensive or integrated approach. [18]. Likewise, variability in administration methods (e.g., self-administration vs. professional-led, timing of assessments, type of personnel involved), heterogeneity in the tools used, and multiple barriers associated with data collection processes (e.g., required human and material resources, low patient response rates) have been described [20, 21]. Nonetheless, several facilitating factors have been identified, including the integration of outcome assessment strategies into routine care, the engagement of patients and their families, and the use of new technologies such as digital tools like mobile health applications, web-based monitoring platforms and electronic symptom trackers [7, 17, 19, 22-25]. To develop more coherent, accessible, and sustainable long-term outcome assessment strategies in trauma survivors, it is crucial to map existing health outcome measurement tools. Furthermore, describing the resources mobilized for their implementation after discharge, along with barriers and facilitators to their feasibility, will inform future models for follow-up outcome assessment [7, 26, 27]. Ultimately, effective implementation of such models can enhance continuity of care and support long-term recovery for trauma survivors. METHODOLOGY We will conduct a scoping review based on the methodological framework developed by Arksey and O’Malley (2005), structured into six stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) data extraction and analysis, (5) collating, summarizing, and reporting the results, and (6) stakeholder consultation to enrich or validate the findings [28, 29]. This protocol was developed in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews (JBI Scoping Review Methodology) [30, 31], and the results will be reported following the PRISMA-ScR checklist [30, 32]. This protocol has been pre-registered on the Open Science Framework (OSF). STEP 1: Identifying the Research Question This scoping review aims to map the nature and extent of available data on strategies used to measure outcomes in survivors of traumatic injuries following hospital discharge. It will focus specifically on outcome measurement, such as PROMs and other types of clinical, functional, psychological, social, or administrative indicators, obtained from routinely collected data or obtained directly from patients. This review will not address follow-up care delivery, but rather how outcomes are captured and assessed post-discharge. More specifically, this review seeks to identify: 1) The outcome assessment strategies used to evaluate the long-term outcomes of trauma survivors, including the tools and instruments employed (including, but not limited to, PROMs); 2) The characteristics of these assessment strategies (e.g., type of outcome measured, mode of administration, timing within the care trajectory, frequency and duration of follow-up, individuals responsible for data collection); 3) The human resources involved (e.g., clinical staff, researchers and data analysts, administrative personnel, healthcare professionals or information systems technicians) and material resources required (e.g., standardized measurement tools, data collection software, administrative or clinical databases, computer equipment, remote communication tools) required to implement these strategies; 4) The barriers and facilitators to the implementation of the outcome assessment strategies, including their perceived relevance and the extent to which these strategies are adapted to patients’ needs; 5) The costs associated with their implementation. 6) The sustainability or continuation of the assessment strategies beyond the study period. Eligibility Criteria The inclusion and exclusion criteria are based on the population/concept/context framework for scoping reviews, as recommended in the methodological guidelines of the JBI [33]. Population: We will include all studies reporting outcome assessment strategies for adult or pediatric patients who have sustained traumatic injuries (i.e., traumatic brain injury, spinal cord injury, visceral organ injuries, orthopaedic injuries) requiring hospitalization, regardless of injury mechanism. Studies must clearly specify that participants were hospitalized due to physical traumatic injuries. Studies focusing exclusively on patients with burns will be excluded because these patients are often managed by specialized teams distinct from general trauma care. Concept: We will focus on structured strategies to assess in the post-discharge period following hospitalization for trauma. Studies must address concrete modali