Mitigating Injury Disparities with Evidence Based Trauma Systems Planning

年，创伤性损伤在美国造成20多万人死亡， 2019.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 and mortality.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 护理是造成这些伤害差异的重要因素，但目前的证据并没有确定或量化 可能减少健康差距的具体系统一级干预措施。我们提出以下目标， 确定减轻创伤结果差异的战略： 目的1：检查创伤系统计划在创伤不存在差异的州的方法 结果。我们将进行一系列深入的案例研究与有目的的样本状态创伤系统 （n=10）根据2000-2020年的伤害死亡率趋势确定。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相关者的访谈（例如，医务主任， 护士管理人员），我们将研究创伤系统规划的整体方法，并特别探讨 旨在解决差异的规划决策。 目标2：识别与损伤差异相关的可修改的创伤系统特征， 分解造成伤害差异的结构途径。我们将进行一次全国性的调查， 创伤系统识别现有的创伤系统资源（例如，基础设施、人员），然后进行链接调查 来自疾病控制中心和医疗保健研究机构的结果数据的回应 和质量在确定了与差异之间的损伤结果相关的创伤系统特征后， 人群，我们将使用中介途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：通过创伤系统规划确定并优先考虑减轻伤害差异的策略 和资源分配。我们将与国家利益攸关方合作，举办一次德尔菲共识小组会议 国家创伤研究联盟（CNTR）我们将要求小组成员评估和优先考虑 建议创伤系统干预措施，以减轻差距，借鉴目标1的结果， 2、从文学。 拟议工作的影响：我们拟议的工作将促进公平的创伤护理， 创伤系统规划的方法，确定介导损伤的特定创伤护理资源 差异，并确定可行的战略，以解决创伤系统层面的差异。我们 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.