Do new trauma centers provide needed or redundant access? A nationwide analysis.
Do new trauma centers provide needed or redundant access? A nationwide analysis.
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DOI：
10.1097/ta.0000000000003652
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发表时间：
2022-09-01
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我们之前的研究表明，增加一个州的创伤中心（tc）的数量并不能可靠地提高州一级的伤害相关死亡率。我们假设许多新的TC将服务于现有TC已经服务的人群，而不是服务于没有现成TC通道的地区。我们还假设，新的tc也不太可能服务于经济上处于不利地位的人群。使用ArcGIS Pro绘制了2014年和2019年在美国创伤学会注册的所有州指定的成人tc。TCs分为1-2级（Lev12）或3-5级（Lev345）。我们还获得了人口普查地区水平的数据（73,666个地区），包括人口数量和低于联邦贫困线的人口百分比。在每个TC周围创建了30分钟的驾驶时间区域。如果人口普查区的地理中心位于任何一个TC的30分钟车程范围内，则被认为是“服务”的。数据是在人口普查区一级进行分析的。2019年发现了2140个TC，其中新TC 256个，关闭TC 151个。82%的新TC为3-5级。在全国范围内，覆盖率从2014年的75.3%增加到2019年的78.1%，人口覆盖率从76.0%增加到79.4%。新中心服务17,532幅，其中87.3%已提供服务。新第12级交通服务中心服务9,100幅土地，其中91.2%已获服务；新列支那345个谘询中心为15,728幅地提供服务，其中85.9%已获服务。在2204个新服务小区中，345级TCs服务的平均贫困率高于12级TCs服务的平均贫困率（15.7% vs 13.2%, p<0.05）。总体而言，在美国，创伤护理的可及性一直在改善。然而，大多数新tc开设在已有创伤护理的地点。在全国范围内，3级、4级和5级tc负责扩大服务不足人群的可及性。
Our prior research has demonstrated that increasing the number of trauma centers (TCs) in a state does not reliably improve state-level injury-related mortality. We hypothesized that many new TCs would serve populations already served by existing TCs, rather than in areas without ready TC access. We also hypothesized that new TCs would also be less likely to serve economically disadvantaged populations. All state-designated adult TCs registered with the American Trauma Society in 2014 and 2019 were mapped using ArcGIS Pro. TCs were grouped as Level 1–2 (Lev12) or level 3–5 (Lev345). We also obtained census tract-level data (73,666 tracts), including population counts and % of population below the federal poverty threshold. Thirty-minute drive-time areas were created around each TC. Census tracts were considered “served” if their geographic centers were located within a 30-minute drive-time area to any TC. Data were analyzed at the census tract-level. 2140 TCs were identified in 2019, with 256 new TCs and 151 TC closures. 82% of new TC were Level 3–5. Nationwide, coverage increased from 75.3% of tracts served in 2014 to 78.1% in 2019, representing an increased coverage from 76.0% to 79.4% of the population. New TC served 17,532 tracts, of which 87.3% were already served. New Lev12 TCs served 9,100 tracts, of which 91.2% were already served; New Lev345 TCs served 15,728 tracts, of which 85.9% were already served. Of 2,204 newly served tracts, those served by Lev345 TCs had higher mean % poverty compared with those served by Lev12 TCs (15.7% vs 13.2% poverty, p<0.05). Overall, access to trauma care has been improving in the United States. However, the majority of new TCs opened in locations with pre-existing access to trauma care. Nationwide, Level 3, 4, and 5 TCs have been responsible for expanding access to underserved populations.