Achieving Injury-related Health Equity in the National Trauma Healthcare System

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ABSTRACT The consequences of injuries and violence disproportionately impact persons of color, uninsured individuals, those with limited English proficiency, and those who are geographically isolated. Injuries are the leading cause of death and disability for those aged 1-44 years in the US, and each year 2.5 million individuals are hospitalized and 26.9 million are treated in the Emergency Department as a result of injuries. Total lifetime medical and work loss costs associated with injuries are estimated at $671 billion/year. Existing state-level trauma registry systems currently collect data on injuries, injury care, and patient characteristics and contribute these data to the national trauma databank and the Trauma Quality Improvement Program of the American College of Surgeons. However, there are significant limitations in the current trauma registry systems. Data are not collected on equity-related factors beyond race, such as primary language spoken or income or on longer- term outcomes after hospital discharge. Our group conducted a national Delphi process with key experts to identify a national agenda in injury and health equity. Key priorities included: 1) Inclusion of health equity- related measures in trauma registries and 2) Need for longer-term follow up of patients to examine how local practices and system factors affect the health of injured patients over time and lead to outcome disparities. Systematically accounting for care factors and outcomes by health-equity measures is a critical step towards developing system-level interventions to alleviate health disparities. This study aims to address these priorities within our Trauma Registry system by developing and testing the feasibility of a culturally sensitive data collection instrument and process that can be included in the existing trauma registry systems to capture health equity measures and longer-term outcomes for diverse trauma patients. We will also examine the relationship between health equity measures and longer-term outcomes in a cohort of injury patients. The overarching goal of this proposal is to reduce injury disparities, improve the survival rates and health of trauma patients, and advance equitable injury care. Results of this study will demonstrate that inclusion of health equity measures and longer-term tracking of outcomes allows for identification of important outcomes associated with health equity measures. This will inform creation of prevention and post-injury intervention efforts that will have sustained impact on the lives of vulnerable persons most at risk for injury and violence.