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

创伤中心的特点可提高下肢损伤的质量、成本和效率

• 批准号: 10438921
• 负责人: Bryant Oliphant
• 金额: $ 9.38万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10438921
• 关键词: Address; Affect; Automobile Driving; Awareness; Caring; Characteristics; Clinical; Comprehensive Health Care; Continuity of Patient Care; Cost efficiency; Country; Data; Data Set; Durable Medical Equipment; Economic Burden; Environment; Essential worker; Evaluation; Expert Opinion; Facilities and Administrative Costs; Feedback; Goals; Guidelines; Health Services; Health Services Research; Health system; Hospitals; Human Resources; Individual; Infection; Injury; Inpatients; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Length of Stay; Link; Longterm Follow-up; Lower Extremity; Medical; Mentorship; Methods; Michigan; Minor; Orthopedic Surgery; Orthopedics; Outcome; Pain; Patient Care; Patient-Focused Outcomes; Patients; Physical therapy; Policies; Process; Provider; Registries; Rehabilitation therapy; Research; Research Personnel; Research Proposals; Resources; Risk; Risk Adjustment; Scientist; Severities; Site Visit; Structure; Surgeon; System; Time; Training; Trauma; Treatment Cost; Triage; United States; Variant; Work; base; care coordination; care episode; career; comorbidity; cost; data infrastructure; data registry; demographics; disability; experience; health care delivery; improved; improved outcome; innovation; limb injury; multidisciplinary; multilevel analysis; population based; precision medicine; programs; research and development; tertiary care; trauma care; trauma centers

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.

项目摘要 每年在创伤中心（TC）中对超过345,000名患者进行下肢损伤（LEI）治疗 曼联代表。 由于工作损失而导致的间接费用。 并有可能导致长期残疾。 需要资源，员工专业知识和护理协调。 标准，包括结构（例如物理资源，提供者技能）以及过程（例如干预时间）。 TC Leaver指定从I（CompreeHentim Care）到 III（评估和稳定），通常是指导分类和转移的基本框架 但是，治疗的决定很少 名称可以或shoud用于此目的，因为它们主要基于“专家意见”评估者 比数据是未知的。 LEI患者的最佳结果。 有了丰富的创伤注册表，成本和利用数据，该提案与评估LEI的患者从 他们的初始奶头课程的初始课程，并将探索对提供高价值重要的因素 护理。特定的研究目的是评估：（1） TCS（2）LEI患者的总体发作支出和治疗效率的差异 TCS（3）驱动Lei Patation高质量效率护理的TC的特征。 基于人群的LEI评估将跟随Patation患者，尽管这是可能的 由于链接数据集的创新方法，以捕获生命的释放后信息 这对于跟踪骨科结局（例如感染，恶意和骨不连）至关重要 受伤后的几周和月份。 确定关键特征在推动最佳效率护理中很重要的影响。 这项研究建议，经验丰富的多学科指导团队和无与伦比的 研究环境将满足候选人布莱恩·奥利普尔（Bryant Olipher）的职业目标和教育需求 MD，MSC，该提案无关 这项研究和奥利普尔博士作为医疗服务研究员和领导者的发展 创伤政策。培训包括医疗保健提供系统的研究生课程 方法和手段来理解政策对研究的解释。 开发奖威尔将为奥利宾人博士成为一名独立临床科学家的基础，并 进行创新的卫生服务研究，是改善该国护理的领导者。