The comparative effectiveness of time-adjusted trauma center care on mortality

描述（由申请人提供）：Brendan G. Carr，医学博士是临床科学家发展奖的申请人。自2008年7月1日起，Garr博士将担任宾夕法尼亚大学医学院急诊医学和流行病学助理教授。他完成了急诊医学、流行病学、创伤和外科重症监护以及卫生政策研究方面的培训。卡尔博士的近期目标是扩大他在高级卫生服务研究、地理分析和系统理论方面的培训。这将作为一个独立研究项目的基础，将紧急护理系统的设计与改善患者的预后联系起来。他组建了一个指导小组，包括创伤护理、卫生服务研究和流行病学方面的国家领导人。拟议的工作旨在提高对院前时间如何影响需要及时紧急护理的条件的结果的理解。创伤就是这样一种情况。美国创伤护理系统已被医学研究所认定为区域化紧急护理服务的典范，并将作为本分析的重点。具体目标是：(1)产生有效的院前旅行时间估计，(2)完成第一次全国代表性的创伤中心医院对伤害死亡率的影响分析，以及(3)调查院前时间对创伤中心与伤害死亡率之间关系的影响。这些目标将通过首先使用院前驾驶速度和从病人到医院的距离计算估计的院前时间来实现，这些时间将与州创伤登记处记录的实际时间进行比较。接下来，来自全国住院病人样本数据库的数据将与创伤中心水平相关联，以分析创伤中心水平对结果的影响。最后，院前时间估计将纳入模型。更好地了解院前时间和创伤中心水平对患者预后的作用，将为创伤护理管理决策提供信息，并最终支持政策决策，以优化急诊护理系统的设计。与此同时，申请人将成为国家领导人，能够开展进一步为这些政策提供信息并将证据转化为实践所需的研究。

DESCRIPTION (provided by applicant): Brendan G. Carr, MD is an applicant for a Mentored Clinical Scientist Development Award. As of July 1, 2008, Dr. Garr will be an Assistant Professor of Emergency Medicine and Epidemiology at the University of Pennsylvania, School of Medicine. He has completed training in emergency medicine, epidemiology, trauma & surgical critical care, and health policy research. Dr. Carr's immediate goals are to expand his training in advanced health services research, geographical analysis, and systems theory. This will serve as a basis for an independent research program linking the design of the emergency care system to improved patient outcomes. He has assembled a mentoring team including national leaders in trauma care, health services research, and epidemiology. The proposed work seeks to improve understanding of how prehospital time impacts outcomes from conditions that require prompt emergency care. Trauma is one such condition. The US trauma care system has been recognized by the Institute of Medicine as a model of regionalized emergency care delivery and will serve as the focus of this analysis. The specific aims are: (1) to produce valid estimates of prehospital travel time, (2) to complete the first nationally representative analysis of the effect of trauma center hospitals on injury mortality, and (3) to investigate the impact of prehospital time on the relationship between trauma centers and injury mortality. These aims will be accomplished by first calculating estimated prehospital times using prehospital driving speeds and distances from patients to hospitals that will be compared to actual times recorded by state trauma registries. Next, data from the Nationwide Inpatient Sample database will be linked to trauma center level to analyze the impact of trauma center level on outcomes. Finally, prehospital time estimates will be incorporated into the model. An improved understanding of the role of prehospital time and trauma center level on patient outcomes will inform trauma care management decisions and ultimately support policy decisions to optimize the design of the emergency care system. In parallel, the applicant will emerge as a national leader able to conduct the research needed to further inform these policies and translate evidence into practice.