Regional Trauma Systems of Care to Address Rural Disparities in Injury Mortality

摘要 创伤性损伤，定义为突然和严重的身体伤害，是死亡和寿命的主要原因 迷失在美国。区域创伤系统，其中紧急医疗提供者和急性护理 设施整合和协调伤员的分类和治疗，在美国广泛实施。 并被证明可以通过创伤中心的统一专业护理降低死亡率。难以获得 创伤中心是造成农村居民创伤死亡率较高的重要因素 社区.尽管区域创伤系统努力确保为所有患者提供及时、高质量的护理， 农村、种族、民族和社会经济方面的创伤死亡率差异仍然很大。有一个 迫切需要了解不同农村和其他地区与创伤有关的差异的原因， 服务不足的人群。我们提出，需要系统科学来理解 （c）评估与创伤有关的差异，并确定针对农村和其他得不到充分服务的人口的高效干预措施。 我们的长期研究目标是使用复杂系统理论和仿真建模来设计，实施， 并评估区域化创伤护理的系统级变化，以改善人口健康和解决 健康差距。系统动力学是复杂动态系统的既定建模方法， 多重因果关系和反馈循环。在这个国家少数民族健康和健康研究所 差异（NIMHD）R21建议，我们的短期目标是制定一个区域因果循环图， 通过对现有数据和关键利益相关者的投入进行二次分析，了解创伤系统。我们将创建一个 一个综合数据集，将北卡罗来纳州现有的关于EMS和院内创伤的全州数据联系起来 护理，创伤患者死亡率，以及患者和社区人口统计学和社会经济地位。到 补充这些定量数据，我们将使区域创伤系统的利益相关者和主题 定性系统动力学方法。我们的具体目标是：（1）评估农村，种族-民族， 北卡罗来纳州创伤患者在创伤分诊和长期死亡率方面的社会经济差异; 以及（2）通过利益相关者为北卡罗来纳州的区域创伤系统创建因果循环图 参与确定潜在的高影响力干预措施，以解决创伤差异。一旦成功 完成这些目标后，我们将获得有关创伤相关差异的基本初步数据， 农村和其他分组进行系统动力学研究，以了解和改善人口健康 和服务水平低下人群的护理质量。建议的研究和我们的长期研究目标 对卫生系统建模产生重大科学影响的潜力，可以直接有助于改善 对于经历急性、危及生命的疾病和损伤的患者的结局。

Abstract Traumatic injury, defined as sudden and severe physical injury, is a leading cause of death and years of life lost in the United States. Regional trauma systems, in which emergency medical providers and acute care facilities integrate and coordinate triage and treatment of injured patients, are broadly implemented in the U.S. and proven to reduce mortality through consolidated, specialized care at trauma centers. Limited access to trauma centers is an important contributor to greater trauma mortality among people living in rural communities. Despite efforts of regional trauma systems to ensure timely, high-quality care for all patients, disparities in trauma mortality by rurality, race, ethnicity, and socioeconomic remain widespread. There is an immediate need to understand the causes of trauma-related disparities across diverse rural and other underserved populations. We propose systems science is needed to understand the causal mechanisms of trauma-related disparities and identify high-impact interventions for rural and other underserved populations. Our long-term research goal is to use complex systems theory and simulation modeling to design, implement, and evaluate system-level changes to regionalized trauma care that improve population health and address health disparities. System dynamics is an established modeling approach for complex, dynamic systems with multiple cause-effect relationships and feedback loops. In this National Institute on Minority Health and Health Disparities (NIMHD) R21 proposal, our short-term objective is to develop a causal loop diagram of regional trauma systems informed by secondary analysis of existing data and key stakeholder input. We will create a comprehensive dataset linking existing statewide data from North Carolina on EMS and in-hospital trauma care, trauma patient mortality, and patient and community demographics and socioeconomic status. To complement these quantitative data, we will engage regional trauma system stakeholders and subject matter experts with qualitative system dynamics methods. Our specific aims are to: (1) evaluate rural, racial-ethnic, and socioeconomic disparities in trauma triage and long-term mortality among North Carolina trauma patients; and (2) create a causal loop diagram for a regional trauma system in North Carolina through stakeholder engagement to identify potential high-impact interventions to address trauma disparities. Upon successful completion of these aims, we will have produced essential preliminary data on trauma-related disparities in rural and other subgroups to pursue system dynamics research to understand and improve population health and quality of care for underserved populations. The proposed research and our long-term research goal has potential for significant scientific impact on health systems modeling that can directly contribute to improving outcomes for patients experiencing acute, life-threatening illness and injury.