Trauma Center Characteristics that Drive Quality, Cost and Efficiency in Lower Extremity Injuries

创伤中心的特点可提高下肢损伤的质量、成本和效率

• 批准号: 10281405
• 负责人: Bryant Oliphant
• 金额: $ 9.38万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10281405
• 关键词: Address; Affect; Automobile Driving; Awareness; Caring; Characteristics; Clinical; Comprehensive Health Care; Continuity of Patient Care; Cost efficiency; Country; Data; Data Set; Durable Medical Equipment; Economic Burden; Environment; Evaluation; Expert Opinion; Facilities and Administrative Costs; Feedback; Goals; Guidelines; Health Services; Health Services Research; Health system; Hospitals; Human Resources; Individual; Infection; Injury; Inpatients; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Length of Stay; Link; Longterm Follow-up; Lower Extremity; Medical; Mentorship; Methods; Michigan; Minor; Orthopedic Surgery; Orthopedics; Outcome; Pain; Patient Care; Patient-Focused Outcomes; Patients; Physical therapy; Policies; Process; Provider; Registries; Rehabilitation therapy; Research; Research Personnel; Research Proposals; Resources; Risk; Risk Adjustment; Scientist; Severities; Site Visit; Structure; Surgeon; System; Time; Training; Trauma; Treatment Cost; Triage; United States; Variant; Work; base; care coordination; care episode; career; comorbidity; cost; data infrastructure; data registry; demographics; disability; experience; health care delivery; improved; improved outcome; innovation; limb injury; multidisciplinary; multilevel analysis; population based; precision medicine; programs; research and development; tertiary care; trauma care; trauma centers

Project Summary More than 345,000 patients are treated for a lower extremity injury (LEI) each year at trauma centers (TC) in the United States. This represents a substantial societal burden both in the direct treatment costs and the indirect costs due to lost work. These injuries are often painful, require considerable treatment interventions and have the potential to cause long term disability. The most optimal place to treat LEI is at a TC due to the required resources, staff expertise and coordination of care. However, TC capabilities vary based on certain criteria, both structural (e.g. physical resources, provider skillsets) as well as process (e.g. intervention times). This variation in capabilities is displayed by the TC level designation, from I (complete comprehensive care) to III (assessment and stabilization), which often serves as a basic framework to guide triage and transfer decisions for treatment. However, little research has been performed to date examining whether these designations can or should be used for this purpose, since they are mostly based on “expert opinion” rather than data. It is unknown if the criteria that are used for TC level designation are really appropriate to achieve the best outcomes in patients with LEI. Capitalizing on the unique data infrastructure in the state of Michigan, with rich trauma registry, cost and utilization data, this proposal will evaluate patients with LEI from the time of their initial injury through their treatment course and will explore the factors important for delivering high value care. The specific research aims are to evaluate: (1) short and long-term outcomes in patients with LEI across TCs (2) the differences in overall episode spending and treatment efficiencies in patients with LEI at across TCs (3) the characteristics of TCs that drive high quality efficient care of LEI patients. This will be the first population-based evaluation of LEI that will follow patients throughout their continuum of care. This is possible because of the innovative approach of linking datasets together to capture vital post-discharge information which is essential for tracking orthopaedic outcomes (e.g. infection, malunion and nonunion) that occur in the weeks and months after injury. Further, by examining the structures and processes at TCs, this study will have the immediate impact of identifying the key characteristics that are important in driving optimal efficient care. This research proposal, the highly experienced multidisciplinary mentorship team and the unparalleled research environment will address the career goals and educational needs of the candidate, Bryant Oliphant, MD, MBA, MSc. The proposal includes a detailed educational plan that will guide the successful completion of this research and the development of Dr. Oliphant’s career as a health services researcher and leader in trauma policy. The training includes graduate level courses in health care delivery systems, quantitative methods as well as a hands-on approach to understanding the interplay of research with policy. This career development award will lay the groundwork for Dr. Oliphant to become an independent clinician scientist who performs innovative health services research and is a leader in improving trauma care in this country.

项目摘要 每年有超过345，000名患者在创伤中心（TC）接受下肢损伤（LEI）治疗， 美国的这在直接治疗费用和治疗费用方面都是一个巨大的社会负担。 因工作损失而产生的间接费用。这些损伤通常是痛苦的，需要相当多的治疗干预 并有可能导致长期残疾。治疗LEI的最佳地点是TC，因为 所需的资源、工作人员的专业知识和护理协调。然而，TC能力因某些因素而异， 标准，包括结构性标准（如物质资源、提供者技能组合）和过程标准（如干预时间）。 这种能力的变化通过TC级别标识显示出来，从I（完全综合护理）到 III（评估和稳定），通常作为指导分流和转移的基本框架 决定治疗。然而，迄今为止，很少有研究检查这些 指定可以或应该用于这一目的，因为它们大多基于“专家意见”，而不是 比数据。目前还不清楚用于TC级别指定的标准是否真的适合实现 LEI患者的最佳结局。利用密歇根州独特的数据基础设施， 由于有丰富的创伤登记、费用和利用数据，该提案将从 他们在治疗过程中的初始损伤，并将探讨提供高价值的重要因素 在乎具体的研究目的是评估：（1）LEI患者的短期和长期结果， TC（2）不同时间LEI患者的总体发作费用和治疗效率的差异 TC（3）推动LEI患者高质量高效护理的TC特征。这将是第一 基于人群的LEI评估，将在患者的整个护理过程中进行随访。这是可能 由于将数据集连接在一起以获取重要的出院后信息的创新方法， 这对于跟踪骨科结局（例如感染、畸形愈合和骨不连）至关重要， 受伤后的几周和几个月。此外，通过审查技术合作中心的结构和程序，本研究将 确定在推动最佳有效护理方面重要的关键特征的直接影响。 这项研究提案，经验丰富的多学科导师团队和无与伦比的 研究环境将解决候选人的职业目标和教育需求，布莱恩特奥列芬特， MD，MBA，MSc.该提案包括一个详细的教育计划，该计划将指导成功完成 这项研究和发展博士奥列芬特的职业生涯作为一个卫生服务研究员和领导者， 创伤政策培训内容包括卫生保健提供系统的研究生课程，定量 方法以及动手的方法来理解研究与政策的相互作用。这个职业 发展奖将为奥列芬特博士成为一名独立的临床科学家奠定基础， 进行创新的卫生服务研究，是改善创伤护理在这个国家的领导者。