TBI Post-Acute Care Clinic Collaborative

Improving recovery after concussion and other traumatic brain injuries

The TBI Post-Acute Care Collaborative is a network of leading academic medical centers working together to improve care for patients experiencing persistent symptoms after concussion and other traumatic brain injuries.

Through shared clinical models, standardized assessments, and coordinated data analysis, participating institutions aim to improve recovery and reduce gaps in post-acute brain injury care.

The Challenge

Every year millions of people experience concussion or mild traumatic brain injury. While many recover within weeks, others develop persistent symptoms affecting cognition, balance, sleep, mood, and daily functioning.

For these patients, the path to recovery is often fragmented, difficult, and long. Care may involve multiple specialists with limited coordination, and most patients receive little follow-up after leaving the hospital.

“I had migraine headaches, and I also needed to use a walker and a shower chair because I was dealing with balance issues two months after.”

A New Model of Care

The collaborative supports the development of model post-acute care clinics focused on patients recovering from concussion and other traumatic brain injuries.

These clinics bring together multidisciplinary teams to address the full range of symptoms that can follow brain injury. Core elements include:

  • Multidisciplinary clinical care — including neurosurgeons, neurologists, physiatrists, psychologists, psychiatrists, and rehabilitation specialists.

  • Full-time patient coordinator.

  • Weekly multidisciplinary care team conferences.

  • Standardized patient symptom assessments.

  • Proactive, coordinated follow-up after injury.

  • Shared data and learning across institutions.

“For me, the long term is right now — memory issues, depression, remembering things, mumbling, ringing in the ears.”

Participating Institutions

A national network of academic medical centers is working together to advance recovery after brain injury:

  • — Weill Institute for Neurosciences, University of California, San Francisco

  • — Rockefeller Neuroscience Institute, West Virginia University, Morgantown

  • — Gardner Neuroscience Institute, University of Cincinnati

  • — University of Pittsburgh Medical Center

  • — Indiana University School of Medicine, Indianapolis

  • — University of Chicago Medical Center

  • — Yale University School of Medicine, New Haven

  • — Medical College of Wisconsin, Milwaukee

  • — Vanderbilt University Medical Center, Nashville

  • — University of Pennsylvania Medical Center, Philadelphia

  • — Duke University School of Medicine, Durham

  • — University Health Network, University of Toronto

“Patients with concussion often fall between specialties. Coordinated care allows us to address the full range of symptoms and learn from each other across institutions.”
— Collaborative Physician

Origins

The Collaborative builds on work by the National Academies of Sciences, Engineering, and Medicine’s Action Collaborative on Traumatic Brain Injury, which identified the need for improved coordination of post-acute care. The launch of each clinic has been made possible by the Sandy & Joan Weill Family Foundation and UCSF.

Coordinated By

The collaborative is coordinated by the Brain Care Catalyst Foundation, a nonprofit dedicated to innovation in brain injury care and improved patient outcomes.e and improved patient outcomes.