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

项目摘要/摘要 创伤是46岁及以下儿童和成年人的主要死亡原因，导致更多美国人死亡 比艾滋病和中风加起来还多。非洲裔美国人(OR1.2，P&lt；0.001)，生活在高度贫困中的人 社区(OR1.01，P&lt；0.001)和那些参加公共医疗保险计划的人(OR1.53， P&lt；0.001)与受伤的同行相比，创伤后的死亡率增加了。量化 在获得紧急医疗服务(EMS)和指定/认证创伤中心(TCS)方面的公平性，如 以及及时获得护理在多大程度上改善健康结果是关键的第一步 这种令人震惊的差异。EMS的公平可用性尚未评估，TCS的公平访问是 未得到充分研究。事实上，还没有人探讨过迅速获得紧急医疗服务的重要性 EMS等服务和及时获得紧急创伤护理是健康的关键社会决定因素 (SDOH)。评估SDOH作为这些差异的主要预测因子的作用的模型仍未得到检验。快速 前往TC的交通与25%的死亡率降低有关；然而，近4500万美国人缺乏 及时获得经过验证的TC。与白人人口相比，最近的数据显示，种族/少数民族 人群获得TC的机会明显较少，创伤后的结果更差。理解 决定与创伤相关的社会空间差异的因素可以为这两项政策的干预提供信息 和系统级别，以减轻小型化所经历的过多的死亡人数 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 消除紧急创伤护理系统院前阶段的社会空间差异，以 改善患者的预后。评估在可获得性和获得EMS和 危重创伤患者的TCS，我们将应用健康公平可测量框架(HEMF) 到紧急创伤护理系统的入院前阶段(EMS的可用性、EMS响应时间、 EMS现场时间、EMS运输时间、EMS决定运输到TCS还是非TCS，以及EMS总数 院前时间)，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特别适合我们建议的研究，因为它是 旨在以因果框架描述SDOH，以指导对以下方面的健康公平的量化分析 对危重伤者进行持续的院前创伤护理监测和随后的政策制定。我们的 跨学科团队将使用数据科学方法和新颖的分析方法来解决这一关键的公共卫生问题 需要通过确定院前急救创伤护理系统一级的健康差距。

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.