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

摘要 创伤性损伤被定义为突然和严重的身体损伤，是导致死亡和长寿的主要原因。 迷失在美国。区域创伤系统，其中紧急医疗服务提供者和急救人员 整合和协调伤员分诊和治疗的设施在美国得到广泛实施。 事实证明，通过在创伤中心进行综合的专门护理，可以降低死亡率。访问权限有限 创伤中心是农村居民创伤死亡率增加的重要原因 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相关的差异的原因 服务不足的人群。我们认为，需要系统科学来理解 与创伤相关的差距，并确定对农村和其他未得到充分服务的人群采取的高影响干预措施。 我们的长期研究目标是利用复杂系统理论和仿真建模来设计、实现、 并评估系统级别的变化，以改善人口健康并解决创伤护理区域化问题 健康差距。系统动力学是一种成熟的复杂、动态系统的建模方法 多个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提案，我们的短期目标是开发区域 创伤系统通过对现有数据和关键利益攸关方的投入进行二次分析而获得信息。我们将创建一个 综合数据集将北卡罗来纳州现有的EMS和住院创伤数据联系起来 护理、创伤患者死亡率、患者和社区人口统计数据以及社会经济状况。至 补充这些量化数据，我们将与区域创伤系统利益攸关方和主题进行接触 具有定性系统动力学方法的专家。我们的具体目标是：(1)评估农村、种族、民族、 以及北卡罗来纳州创伤患者在创伤分类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环图 参与确定潜在的高影响力干预措施，以解决创伤差异问题。成功后 完成这些目标后，我们将产生有关创伤相关差距的重要初步数据。 农村和其他小组进行系统动力学研究，以了解和改善人口健康 以及对未得到充分服务的人群的护理质量。建议的研究和我们的长期研究目标是 可能对卫生系统建模产生重大科学影响，从而直接有助于改进 对于患有危及生命的急性疾病和伤害的患者的结果。

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.