County Trauma Systems and Outcomes Disparities

描述（由申请人提供）：使用现有的县特定数据，识别和评价与机动车碰撞后更好的健康结局相关的潜在可修改的院前因素。研究设计：一系列相关的研究，使用多年的政府数据库相互连接，并使用确定性和概率方法的额外数据。小地区（县）的变异性和变化随着时间的推移将被描述。结果分析将使用多级回归来解释聚类数据结构（例如，人<县<州<年）。环境和参与者：来自受伤美国人的人口普查和样本数据，记录在国家生命统计系统（NVSS）、死亡分析报告系统（法尔斯）、国家汽车抽样系统（NASS）和其他文件中。解释变量：结构和过程变量描述当地创伤系统的县（或相关的邮政编码），包括：EMT能力的水平;国家创伤系统的特点;交通安全立法的影响;平均距离空中救护车或创伤中心;平均EMS响应和运输时间致命的交通事故。这些潜在可修改因素的变化将根据地理、人口统计学和驾驶暴露的测量结果进行报告;一个县随时间的变化将被视为当地可修改因素的进一步证据。结局指标：基于人群的交通死亡率（NVSS/法尔斯）;基于车祸的死亡率、住院时间和误工时间（NASS）;以及除首例死亡以外的法尔斯受试者的生存率（法尔斯）。结局将建模为上述院前解释变量（尤其是确定为可修改的变量）的可能函数，同时控制固定的地理/人口统计学因素和随机的个人/事件因素。公共卫生相关性：该项目提供了一个机会，收集现有数据，并应用当代统计方法来评估创伤系统的院前组成部分。通过合并来自多种来源的数据，并适当控制不同汇总级别变量的影响，拟议的项目将向决策者和创伤系统管理人员提供有关系统改进的宝贵信息，这些系统改进可使个人，特别是生活在农村地区的个人受益。

DESCRIPTION (provided by applicant): To identify and evaluate potentially modifiable pre-hospital factors associated with better health outcomes after motor vehicle collisions, using existing county-specific data. Study Design: A series of related studies using multiple-year government databases linked to each other and to additional data using deterministic and probabilistic methods. Small-area (county) variability and changes over time will be described. Outcome analysis will use multilevel regression to account for clustered data structures (e.g., persons < counties < states < years). Setting and Participants: Census and sample data from injured Americans, as recorded in National Vital Statistics System (NVSS), Fatality Analysis Reporting System (FARS), National Automotive Sampling System (NASS), and other files. Explanatory variables: Structural and process variables describing local trauma systems by county (or related ZIP code) including: Levels of EMT capability; state trauma system characteristics; traffic safety legislation in effect; mean distance from air ambulances or trauma centers; mean EMS response and transport times for fatal traffic crashes. Variation in these potentially modifiable factors will be reported with respect to measures of geography, demography, and driving exposure; changes over time in a county will be considered further evidence of a locally modifiable factor. Outcome Measures: Population-based traffic mortality (NVSS/FARS); crash-based mortality, length of hospitalization, and time lost from work (NASS); and survival of FARS subjects other than the first fatality (FARS). Outcomes will be modeled as possible functions of the above pre-hospital explanatory variables (especially those identified as modifiable), while controlling for fixed geographic/demographic factors and random personal/event factors. PUBLIC HEALTH RELEVANCE: This project presents an opportunity to assemble data already available and apply contemporary statistical methods to evaluate the pre-hospital component of trauma systems. By combining data from multiple sources and controlling properly for the effects of variables at different levels of aggregation, the proposed project will provide valuable information to policy makers and trauma system managers about system improvements that can benefit individuals, particularly those living in rural areas.