Achieving Injury-related Health Equity in the National Trauma Healthcare System

摘要 伤害和暴力的后果对有色人种、没有保险的个人、 英语水平有限的人，以及地理上与世隔绝的人。伤病是最主要的 在美国，1-44岁的人的死因和残疾，每年有250万人 另有2690万人因受伤在急诊科接受治疗。总寿命 与伤害有关的医疗和工作损失估计为6710亿美元/年。现有州级 创伤登记系统目前收集关于伤害、伤害护理和患者特征的数据，并帮助 这些数据被上传到国家创伤数据库和美国创伤质量改进计划 外科医生学院。然而，目前的创伤登记系统有很大的局限性。数据是 不按种族以外的与公平有关的因素收集，如主要语言或收入或更长时间- 出院后的足月结局。我们小组与主要专家一起进行了全国德尔福进程，以 确定伤害和健康公平方面的国家议程。主要优先事项包括：1)纳入卫生公平-- 创伤登记处的相关措施以及2)需要对患者进行长期随访，以检查局部情况 随着时间的推移，做法和制度因素会影响受伤患者的健康，并导致结果差异。 通过健康公平措施系统地核算护理因素和结果是实现以下目标的关键步骤 制定系统层面的干预措施，以缓解健康差距。这项研究旨在解决这些优先事项 在我们的创伤登记系统中，通过开发和测试文化敏感数据的可行性 可纳入现有创伤登记系统以获取健康状况的收集手段和程序 公平衡量和不同创伤患者的长期结果。我们还将研究两国关系 在一组受伤患者中，健康公平措施与长期结果之间的关系。首要目标是 这项建议的目的是减少伤害差距，提高创伤患者的存活率和健康，以及 推进公平的伤害护理。这项研究的结果将证明，纳入健康公平措施 对结果的长期跟踪可以确定与健康相关的重要结果 股权衡量标准。这将为创建预防和受伤后干预工作提供信息，这些工作将 对最易遭受伤害和暴力风险最大的弱势群体的生活产生持续影响。

ABSTRACT The consequences of injuries and violence disproportionately impact persons of color, uninsured individuals, those with limited English proficiency, and those who are geographically isolated. Injuries are the leading cause of death and disability for those aged 1-44 years in the US, and each year 2.5 million individuals are hospitalized and 26.9 million are treated in the Emergency Department as a result of injuries. Total lifetime medical and work loss costs associated with injuries are estimated at $671 billion/year. Existing state-level trauma registry systems currently collect data on injuries, injury care, and patient characteristics and contribute these data to the national trauma databank and the Trauma Quality Improvement Program of the American College of Surgeons. However, there are significant limitations in the current trauma registry systems. Data are not collected on equity-related factors beyond race, such as primary language spoken or income or on longer- term outcomes after hospital discharge. Our group conducted a national Delphi process with key experts to identify a national agenda in injury and health equity. Key priorities included: 1) Inclusion of health equity- related measures in trauma registries and 2) Need for longer-term follow up of patients to examine how local practices and system factors affect the health of injured patients over time and lead to outcome disparities. Systematically accounting for care factors and outcomes by health-equity measures is a critical step towards developing system-level interventions to alleviate health disparities. This study aims to address these priorities within our Trauma Registry system by developing and testing the feasibility of a culturally sensitive data collection instrument and process that can be included in the existing trauma registry systems to capture health equity measures and longer-term outcomes for diverse trauma patients. We will also examine the relationship between health equity measures and longer-term outcomes in a cohort of injury patients. The overarching goal of this proposal is to reduce injury disparities, improve the survival rates and health of trauma patients, and advance equitable injury care. Results of this study will demonstrate that inclusion of health equity measures and longer-term tracking of outcomes allows for identification of important outcomes associated with health equity measures. This will inform creation of prevention and post-injury intervention efforts that will have sustained impact on the lives of vulnerable persons most at risk for injury and violence.