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: 10438921
• 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/10438921
• 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; Essential worker; 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 每年在创伤中心（TC）中对超过345,000名患者进行下肢损伤（LEI）治疗 美国。这代表了直接治疗费用和 由于工作损失而导致的间接费用。这些伤害通常很痛苦，需要考虑治疗干预措施 并有可能导致长期残疾。由于 需要资源，员工专业知识和护理协调。但是，TC功能因某些人而异 标准，包括结构性（例如物理资源，提供者技能）以及过程（例如干预时间）。 TC级别的设计显示，从I（完整的综合护理）到 III（评估和稳定），通常是指导分类和转移的基本框架 治疗的决定。但是，迄今为止很少进行研究 指定可以或应该用于此目的，因为它们主要基于“专家意见”而不是基于 比数据。未知用于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架构， 有了丰富的创伤注册表，成本和利用数据，该提案将评估LEI患者 他们通过治疗课程的最初受伤，将探索对提供高价值重要的因素 关心。具体研究的目的是评估：（1）LEI患者的短期和长期结局 TCS（2）LEI患者的总体发作支出和治疗效率的差异 TCS（3）TCS的特征可驱动LEI患者高质量护理。这将是第一个 基于人群的LEI评估将在患者持续护理过程中跟随患者。这是可能的 由于将数据集链接在一起以捕获生命的释放后信息的创新方法 这对于追踪骨科结局（例如感染，疟疾和骨不连）至关重要。 受伤后数周和几个月。此外，通过检查TCS的结构和过程，本研究将具有 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。 这项研究建议，经验丰富的多学科指导团队和无与伦比的 研究环境将解决候选人布莱恩·奥利芬特（Bryant Oliphant）的职业目标和教育需求， 医学博士，MBA，MSC。该提案包括一项详细的教育计划，该计划将指导成功完成 这项研究以及奥利芬特博士作为卫生服务研究人员和领导者的职业发展 创伤政策。培训包括医疗保健提供系统的研究生级课程，定量 方法以及动手方法来理解研究与政策的相互作用。这个职业 开发奖将为奥利芬特博士成为一名独立临床科学家奠定基础 进行创新的健康服务研究，是改善该国创伤护理的领导者。