Trauma Center Characteristics that Drive Quality, Cost and Efficiency in Lower Extremity Injuries

项目摘要 每年有超过345,000名患者在创伤中心(TC)接受下肢损伤(LEI)治疗 美国。这是一个巨大的社会负担，包括直接治疗费用和 因失去工作而产生的间接成本。这些伤害通常是痛苦的，需要相当多的治疗干预。 并有可能导致长期残疾。治疗LEI的最佳地点是TC，因为 所需资源、工作人员专业知识和护理协调。然而，TC的能力因某些因素而异 标准，既有结构性的(例如，物质资源、提供者的技能)，也有过程的(例如，干预时间)。 这种能力的变化通过TC级别名称显示，从I(全面护理)到 三(评估和稳定)，通常作为指导分类和转移的基本框架 治疗的决定。然而，到目前为止，几乎没有进行过研究来检验这些 名称可以或应该用于这一目的，因为它们主要基于“专家意见”，而不是 而不是数据。目前尚不清楚用于指定TC级别的标准是否真的适合达到 LEI患者预后最佳。利用密歇根州独特的数据基础设施， 凭借丰富的创伤登记、成本和利用数据，该提案将从 他们的初始损伤通过他们的治疗过程，并将探索重要的因素，以提供高价值 关心。具体的研究目的是评估：(1)LEI患者的短期和长期结果。 TCS(2)交叉试验中LEI患者的总费用和治疗效率的差异 TCS(3)驱动LEI患者高质量、高效率护理的TCS特点。这将是第一次 基于人群的LEI评估将在患者的整个护理过程中进行跟踪。这是可能的 因为采用了将数据集链接在一起以捕获出院后重要信息的创新方法 这对于跟踪发生在骨盆骨折中的骨科结果(例如感染、畸形愈合和骨不连)是必不可少的 受伤后的几周和几个月。此外，通过研究塔塔咨询公司的结构和流程，本研究将具有 确定对推动最佳高效护理非常重要的关键特征的直接影响。 这项研究建议，经验丰富的多学科导师团队和无与伦比 研究环境将解决候选人布莱恩特·奥列芬特的职业目标和教育需求， 医学博士、工商管理硕士、硕士。该提案包括一项详细的教育计划，该计划将指导成功完成 这项研究和奥列芬特博士作为卫生服务研究员和领导者的职业生涯的发展 创伤保险。培训包括卫生保健提供系统的研究生水平课程、量化 方法以及理解研究与政策的相互作用的实践方法。这份职业 发展奖将为奥列芬特博士成为一名独立的临床科学家奠定基础 进行创新的医疗服务研究，在改善这个国家的创伤护理方面处于领先地位。

Project Summary More than 345,000 patients are treated for a lower extremity injury (LEI) each year at trauma centers (TC) in the United States. This represents a substantial societal burden both in the direct treatment costs and the indirect costs due to lost work. These injuries are often painful, require considerable treatment interventions and have the potential to cause long term disability. The most optimal place to treat LEI is at a TC due to the required resources, staff expertise and coordination of care. However, TC capabilities vary based on certain criteria, both structural (e.g. physical resources, provider skillsets) as well as process (e.g. intervention times). This variation in capabilities is displayed by the TC level designation, from I (complete comprehensive care) to III (assessment and stabilization), which often serves as a basic framework to guide triage and transfer decisions for treatment. However, little research has been performed to date examining whether these designations can or should be used for this purpose, since they are mostly based on “expert opinion” rather than data. It is unknown if the criteria that are used for TC level designation are really appropriate to achieve the best outcomes in patients with LEI. Capitalizing on the unique data infrastructure in the state of Michigan, with rich trauma registry, cost and utilization data, this proposal will evaluate patients with LEI from the time of their initial injury through their treatment course and will explore the factors important for delivering high value care. The specific research aims are to evaluate: (1) short and long-term outcomes in patients with LEI across TCs (2) the differences in overall episode spending and treatment efficiencies in patients with LEI at across TCs (3) the characteristics of TCs that drive high quality efficient care of LEI patients. This will be the first population-based evaluation of LEI that will follow patients throughout their continuum of care. This is possible because of the innovative approach of linking datasets together to capture vital post-discharge information which is essential for tracking orthopaedic outcomes (e.g. infection, malunion and nonunion) that occur in the weeks and months after injury. Further, by examining the structures and processes at TCs, this study will have the immediate impact of identifying the key characteristics that are important in driving optimal efficient care. This research proposal, the highly experienced multidisciplinary mentorship team and the unparalleled research environment will address the career goals and educational needs of the candidate, Bryant Oliphant, MD, MBA, MSc. The proposal includes a detailed educational plan that will guide the successful completion of this research and the development of Dr. Oliphant’s career as a health services researcher and leader in trauma policy. The training includes graduate level courses in health care delivery systems, quantitative methods as well as a hands-on approach to understanding the interplay of research with policy. This career development award will lay the groundwork for Dr. Oliphant to become an independent clinician scientist who performs innovative health services research and is a leader in improving trauma care in this country.