A Population-Based Analysis of the Discrepancy Between Potential and Realized Access to Trauma Center Care
A Population-Based Analysis of the Discrepancy Between Potential and Realized Access to Trauma Center Care
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DOI：
10.1097/sla.0b013e31827b9649
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发表时间：
2013-01-01
影响因子：
9
通讯作者：
Nathens, Avery B.
中科院分区：
文献类型：
--
作者：
Gomez, David;Haas, Barbara;Nathens, Avery B.
目的：探讨创伤服务的可用性（潜在的访问）和创伤中心的利用率（实现访问）之间是否存在差异，目的是告知策略，以提高access.Background：缺乏获得创伤中心护理已经常被归因于创伤中心的地理分布。或者，阻碍创伤中心护理可能是由于次优的分流做法，在设置适当的resources.Methods：人口为基础的回顾性队列研究严重受伤的成年患者（2002-2010年）。使用基于网络的人口普查数据的空间分析评估了创伤中心护理的可能性，并将其定义为居住在创伤中心1小时内。使用基于人群的数据源评估了创伤中心护理的实现途径，并将其定义为从受伤现场直接运送到创伤中心。潜在的和实现的访问（高，中，低）之间的一致性进行了评估，在县level.Results：在研究区域的人口，7,340,711人（60%）有潜在的访问创伤中心护理，在11个县（22%）的人有很高的潜在访问。在26，861名严重受伤患者中，10，237名（38%）已实现获得创伤中心护理;只有4个县（8%）的患者实现了高获得。潜在的和实现的访问之间的一致性是中等的（加权。k = 0.49）; 63%的县（n = 7），高潜力的访问表现不如预期，并有中度或低度实现access.Conclusions：有有限的一致性之间的潜在和实现访问。高潜在接入的区域实现接入的程度较低，反之亦然。这项评估表明，改善访问的策略必须基于了解中心的分布和用于访问创伤护理的分诊实践。
Objective: To explore whether a discrepancy between the availability of trauma services (potential access) and trauma center utilization rates (realized access) exists, with the aim of informing strategies to improve access.Background: Lack of access to trauma center care has frequently been attributed to the geographic distribution of trauma centers. Alternatively, impeded access to trauma center care might be due to suboptimal triage practices in the setting of appropriate resources.Methods: Population-based retrospective cohort study of severely injured adult patients (2002-2010). Potential access to trauma center care was evaluated using network-based spatial analysis of census data and was defined as residing within 1 hour of a trauma center. Realized access to trauma center care was evaluated using population-based data sources and was defined as direct transport from the scene of injury to a trauma center. Concordance between potential and realized access (high, moderate, or low) was evaluated at the county level.Results: Of the population in the study region, 7,340,711 persons (60%) had potential access to trauma center care; persons in 11 counties (22%) had high potential access. Of 26,861 severely injured patients, 10,237 (38%) had realized access to trauma center care; patients in only 4 counties (8%) had high realized access. The concordance between potential and realized access was moderate (weighted. k = 0.49); 63% of counties (n = 7) with high potential access performed worse than expected and had moderate or low realized access.Conclusions: There is limited concordance between potential and realized access. Regions with high potential access had low realized access, and vice versa. This evaluation suggests that strategies to improve access must be based on understanding the distribution of centers and the triage practices used to access trauma care.