Health Equity in Emergency Trauma Care: Analysis of disparities in the pre-hospital emergency trauma care system

紧急创伤护理中的健康公平：院前紧急创伤护理系统的差异分析

• 批准号: 10594244
• 负责人: Cherisse D. Berry
• 金额: $ 66.45万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-13 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10594244
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; African American population; American; Area; Automobile Driving; Black race; Caring; Cause of Death; Cessation of life; Child; Data; Data Science; Database Management Systems; Databases; Disparity; District of Columbia; Emergency Care; Emergency Situation; Emergency medical service; Enrollment; Equity; Ethnic Origin; Geography; Goals; Health; Health Services Accessibility; Hospitals; Information Sciences; Information Systems; Inpatients; Insurance Coverage; Intervention; Knowledge; Life; Measurable; Measurement; Methods; Minority Groups; Modeling; Morbidity - disease rate; Neighborhoods; Outcome; Patient-Focused Outcomes; Patients; Persons; Phase; Policies; Policy Developments; Population; Poverty; Public Health; Race; Reaction Time; Research; Role; Socioeconomic Factors; Socioeconomic Status; Stroke; System; Testing; Time; Transportation; Trauma; Trauma patient; Traumatic injury; United States; aged; care systems; cohort; deprivation; design; disparity elimination; disparity reduction; ethnic minority population; experience; health care service; health disparity; health equity; health inequalities; high risk; improved; improved outcome; indexing; injured; intervention effect; mortality; mortality risk; novel; predictive modeling; prevent; programs; public health insurance; racial minority population; segregation; severe injury; social health determinants; spatial epidemiology; spatiotemporal; therapy design; time use; trauma care; trauma centers

PROJECT SUMMARY/ABSTRACT Trauma is the leading cause of death for children and adults 46 years and younger, killing more Americans than AIDS and stroke combined. African Americans (OR 1.2, P<0.001), people living in high poverty neighborhoods (OR 1.01, P<0.001), and those enrolled in public health insurance programs (OR 1.53, P<0.001) have increased mortality after trauma when compared to their injured counterparts. Quantifying the equity in access to Emergency Medical Services (EMS) and designated/verified trauma centers (TCs), as well as the extent to which timely access to care improves health outcomes are critical first steps to address this alarming discrepancy. Equitable availability to EMS has yet to be evaluated and equitable access to TCs is understudied. In fact, no one has explored the importance of expeditious availability to emergency health care services such as EMS and timely access to emergent trauma care as key social determinants of health (SDOH). Models to evaluate the role of SDOH as major predictors of these disparities remain untested. Rapid transport to a TC is associated with a 25% reduction in mortality; however, nearly 45 million Americans lack timely access to a verified TC. When compared to white populations, recent data show racial/ethnic minority populations have significantly less access to TC and worse outcomes following trauma. Understanding the factors that determine trauma-related socio-spatial disparities can inform interventions at both the policy and system levels to mitigate the disproportionately large numbers of deaths experienced by minoritized populations. Thus, there is a compelling need for research in these areas to facilitate targeted interventions to eliminate socio-spatial disparities within the pre-hospital phase of the emergency trauma care system to improve patient outcomes. To evaluate socio-spatial disparities in availability and access to both EMS and to TCs among critically injured trauma patients, we will apply the Health Equity Measurable Framework (HEMF) to the pre-hospital phase of the emergency trauma care system (availability to EMS, EMS response time, EMS scene time, EMS transportation time, EMS decision to transport to TCs vs. non-TCs, and EMS total prehospital time) and use large national databases to develop spatiotemporal models to assess drivers of disparities in traumatic injuries. HEMF will be particularly well suited for our proposed study because it is designed to describe SDOH in a causal framework to guide the quantitative analysis of health equity for ongoing pre-hospital trauma care surveillance of the critically injured and subsequent policy development. Our interdisciplinary team will use data science methods and novel analytics to address this critical public health need by identifying health disparities at the level of the pre-hospital emergency trauma care system.

项目总结/摘要 创伤是儿童和46岁及以下成人死亡的主要原因， 比艾滋病和中风加起来还要多非裔美国人（OR 1.2，P<0.001），生活在高度贫困中的人 社区居民（OR 1.01，P<0.001）和参加公共健康保险的居民（OR 1.53， P<0.001）与受伤的同伴相比，创伤后死亡率增加。量化 公平获得紧急医疗服务（EMS）和指定/经验证的创伤中心（TC）， 以及及时获得医疗服务在多大程度上改善了健康结果，是解决这一问题的关键第一步。 这种惊人的差异。公平获得环管系统的问题尚待评估，公平获得技术合作的问题尚待解决。 替补演员事实上，没有人探讨过快速提供紧急医疗服务的重要性 EMS和及时获得紧急创伤护理等服务是健康的关键社会决定因素 （SDOH）。模型来评估的作用，SDOH作为这些差距的主要预测因素仍然未经测试。快速 转运到TC与死亡率降低25%相关;然而，近4500万美国人缺乏 及时访问经过验证的TC。与白色人群相比，最近的数据显示， 人群在创伤后获得TC的机会显著减少，结局更差。理解 决定创伤相关社会空间差异的因素可以为政策干预提供信息， 和系统水平，以减轻少数民族经历的不成比例的大量死亡， 人口。因此，迫切需要在这些领域进行研究，以促进有针对性的干预措施， 消除创伤急救系统入院前阶段的社会空间差异， 改善患者预后。评价在获得环境管理系统和保健服务方面的社会空间差异， 在严重创伤患者中，我们将应用健康公平可衡量框架（HEMF） 紧急创伤护理系统的院前阶段（EMS的可用性，EMS响应时间， EMS现场时间、EMS运输时间、EMS运输至TC与非TC的决定以及EMS总计 并使用大型国家数据库开发时空模型，以评估 创伤性损伤的差异。HEMF将特别适合我们提出的研究，因为它是 旨在以因果框架描述SDOH，以指导健康公平性的定量分析， 对严重受伤者进行持续的院前创伤护理监测和随后的政策制定。我们 跨学科团队将使用数据科学方法和新颖的分析来解决这一关键的公共卫生问题 通过确定院前紧急创伤护理系统一级的健康差距，