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

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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.