Mitigating Injury Disparities with Evidence Based Trauma Systems Planning

年，创伤在美国造成20多万人死亡和200万潜在寿命年的损失 2019年。黑人、西班牙裔、农村和低收入人群承受着不成比例的伤害发生率负担 和死亡率。越来越多的证据表明，在获得创伤方面存在系统性的不平等 护理是这些伤害差异的重要驱动因素，但目前的证据没有确定或量化 有可能缩小健康差距的具体系统级干预措施。我们提出以下目标： 确定减少创伤结局差异的战略： 目标1：审查在创伤方面没有差异的州进行创伤系统规划的方法 结果。我们将进行一系列有目的的国家创伤系统样本的深入案例研究 (n=10)根据2000-2020年伤害死亡趋势确定。使用文档审阅和半结构化 与各州负责创伤系统规划的利益攸关方(例如，医疗主管、 护士经理)，我们将检查创伤系统规划的总体方法，并具体探讨 旨在解决差异的规划决策。 目标2：确定与损伤差异相关的可修改的创伤系统特征 分解造成损伤差异的结构路径。我们将对国家进行一次全国性的调查 创伤系统以确定现有创伤系统资源(例如基础设施、人员)，然后链接调查 使用疾病控制中心和医疗保健研究机构的结果数据进行回应 和质量。在确定了与不同伤害结果相关的创伤系统特征后 ，我们将使用中介路径模型来分解创伤系统资源的影响 分配作为伤害差异的决定因素。 目标3：确定通过创伤系统规划减少伤害差异的战略并确定优先顺序 和资源分配。我们将与国家利益攸关方合作，举行德尔福共识小组 与国家创伤研究联盟(CNTR)合作。我们将要求小组成员进行评估并确定优先顺序 建议创伤系统干预以减少差异，借鉴AIMS 1和 2、从文献上看。 拟议工作的影响：我们拟议的工作将通过结合当前的情况来促进创伤护理的公平 创伤系统规划的方法，确定调解伤害的特定创伤护理资源 在这方面，我们将继续关注差距问题，并确定在创伤系统一级解决差距问题的可行战略。我们的 与国家创伤领导人的伙伴关系将支持在美国各地的传播和实施。

Traumatic injuries caused more than 200,000 deaths and the loss of 2 Million potential life years in the US in 2019. Black, Hispanic, rural, and low-income populations bear a disproportionate burden of injury incidence and mortality. There is an increasing body of evidence suggesting systematic inequities in access to trauma care are a substantial driver of these injury disparities, but current evidence does not identify or quantify specific system-level interventions that might reduce health disparities. We propose the following aims to identify strategies to mitigate disparities in trauma outcomes: Aim 1: Examine approaches to trauma system planning in states without disparities in trauma outcomes. We will conduct a series of in-depth case studies with a purposive sample of state trauma systems (n=10) identified based on injury mortality trends from 2000-2020. Using document review and semi-structured interviews with stakeholders responsible for trauma system planning in each state (e.g., medical directors, nurse managers), we will examine the overall approach to trauma system planning, and specifically probe for planning decisions intended to address disparities. Aim 2: Identify modifiable trauma system characteristics associated with injury disparities and decompose the structural pathways causing injury disparities. We will conduct a national survey of state trauma systems to identify existing trauma system resources (e.g., infrastructure, personnel), then link survey responses with outcomes data from the Centers for Disease Control and the Agency for Healthcare Research and Quality. After identifying trauma system characteristics associated with injury outcomes among disparities populations, we will use mediation pathway models to decompose the effects of trauma system resource allocation as a determinant of injury disparities. Aim 3: Identify and prioritize strategies to mitigate injury disparities through trauma system planning and resource allocation. We will conduct a Delphi consensus panel with national stakeholders, in partnership with the Coalition for National Trauma Research (CNTR). We will ask panelists to evaluate and prioritize recommendations trauma system interventions to mitigate disparities, drawing from the results of Aims 1 and 2, and from the literature. Impact of proposed work: Our proposed work will facilitate equity in trauma care by contextualizing current approaches to trauma systems planning, identifying specific trauma care resources that mediate injury disparities, and identifying actionable strategies to address disparities at the trauma system level. Our partnerships with national trauma leaders will support dissemination and implementation throughout the US.