Mitigating Injury Disparities with Evidence Based Trauma Systems Planning

通过基于证据的创伤系统规划来减轻伤害差异

• 批准号: 10786608
• 负责人: Molly Price Jarman
• 金额: $ 91.64万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-24 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10786608
• 关键词: Address; Algorithms; American College of Surgeons; Biological Models; Black race; Caring; Case Study; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; Consensus; Data; Disparity; Disparity population; Dissemination and Implementation; Emergency medical service; Engineering; Equity; Ethnic Population; Future; Geographic Locations; Geography; Goals; Hispanic; Hospitals; Human Resources; Improve Access; Incidence; Infrastructure; Injury; Intervention; Interview; Knowledge; Life; Link; Literature; Low Income Population; Low income; Maryland; Measures; Mediating; Mediation; Medical; Medicine; Methods; Modeling; Nurses; Operative Surgical Procedures; Outcome; Pathway interactions; Patients; Persons; Physician Executives; Policy Maker; Population; Process; Protocols documentation; Recommendation; Reduce health disparities; Reporting; Resource Allocation; Resources; Risk Reduction; Rural; Sampling; Series; Signal Transduction; Source; Structure; Surveys; System; Testing; Time; Transportation; Trauma; Trauma Research; Trauma patient; Traumatic injury; Triage; United States Agency for Healthcare Research and Quality; United States National Academy of Sciences; Work; access disparities; black patient; care systems; cost; disparity elimination; disparity reduction; effectiveness evaluation; evidence base; health disparity populations; improved outcome; injury burden; marginalization; mortality; mortality risk; outcome disparities; prevent; programs; racial population; response; rural dwellers; secondary outcome; severe injury; standard care; trauma care; trauma centers; trend

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.

在美国，创伤性伤害造成了20多万人死亡，并损失了200万潜在生命年