Regional Trauma Systems of Care to Address Rural Disparities in Injury Mortality

解决农村伤害死亡率差异的区域创伤护理系统

• 批准号: 10790406
• 负责人: Mehul D. Patel
• 金额: $ 19.83万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10790406
• 关键词: Accident and Emergency department; Acute; Address; American; Biological Models; Caring; Cause of Death; Censuses; Cessation of life; Communities; Community Surveys; Complement; Complex; Data; Data Set; Destinations; Development; Disparity; Emergency medical service; Ensure; Ethnic Origin; Feedback; Goals; Grant; Health Services Research; Health care facility; Health system; Hospital Closures; Hospitals; Information Systems; Injury; Intervention; Left; Life; Link; Medical emergency; Methods; Modeling; National Institute on Minority Health and Health Disparities; North Carolina; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Provider; Qualitative Methods; Quality of Care; Race; Registries; Research; Resources; Rural; Rural Community; Rural Hospitals; Rural Population; Science; Socioeconomic Status; Structure; Subgroup; System; Systems Theory; Testing; Time; Trauma; Trauma patient; Traumatic injury; Triage; Underinsured; Underserved Population; United States; acute care; care systems; demographics; design; dynamic system; ethnic minority; experience; health disparity; holistic approach; improved; improved outcome; indexing; injured; member; model building; models and simulation; mortality; novel strategies; patient subsets; population health; programs; prototype; racial minority; rural area; rural disparities; rural dwellers; rural health disparities; rural underserved; rurality; secondary analysis; socioeconomic disadvantage; socioeconomic disparity; socioeconomic diversity; socioeconomics; theories; trauma care; trauma centers; urban area; years of life lost

Abstract Traumatic injury, defined as sudden and severe physical injury, is a leading cause of death and years of life lost in the United States. Regional trauma systems, in which emergency medical providers and acute care facilities integrate and coordinate triage and treatment of injured patients, are broadly implemented in the U.S. and proven to reduce mortality through consolidated, specialized care at trauma centers. Limited access to trauma centers is an important contributor to greater trauma mortality among people living in rural communities. Despite efforts of regional trauma systems to ensure timely, high-quality care for all patients, disparities in trauma mortality by rurality, race, ethnicity, and socioeconomic remain widespread. There is an immediate need to understand the causes of trauma-related disparities across diverse rural and other underserved populations. We propose systems science is needed to understand the causal mechanisms of trauma-related disparities and identify high-impact interventions for rural and other underserved populations. Our long-term research goal is to use complex systems theory and simulation modeling to design, implement, and evaluate system-level changes to regionalized trauma care that improve population health and address health disparities. System dynamics is an established modeling approach for complex, dynamic systems with multiple cause-effect relationships and feedback loops. In this National Institute on Minority Health and Health Disparities (NIMHD) R21 proposal, our short-term objective is to develop a causal loop diagram of regional trauma systems informed by secondary analysis of existing data and key stakeholder input. We will create a comprehensive dataset linking existing statewide data from North Carolina on EMS and in-hospital trauma care, trauma patient mortality, and patient and community demographics and socioeconomic status. To complement these quantitative data, we will engage regional trauma system stakeholders and subject matter experts with qualitative system dynamics methods. Our specific aims are to: (1) evaluate rural, racial-ethnic, and socioeconomic disparities in trauma triage and long-term mortality among North Carolina trauma patients; and (2) create a causal loop diagram for a regional trauma system in North Carolina through stakeholder engagement to identify potential high-impact interventions to address trauma disparities. Upon successful completion of these aims, we will have produced essential preliminary data on trauma-related disparities in rural and other subgroups to pursue system dynamics research to understand and improve population health and quality of care for underserved populations. The proposed research and our long-term research goal has potential for significant scientific impact on health systems modeling that can directly contribute to improving outcomes for patients experiencing acute, life-threatening illness and injury.

抽象的 创伤性损伤被定义为突然和严重的身体伤害，是死亡的主要原因和生命年的主要原因 在美国迷失。区域创伤系统，紧急医疗提供者和急诊护理 在美国广泛实施了设施整合和协调受伤患者的分类和治疗 并被证明可以通过创伤中心的合并专门护理来降低死亡率。有限的访问权限 创伤中心是居住在农村人群中更大创伤死亡率的重要因素 社区。尽管区域创伤系统努力确保所有患者及时，高质量的护理，但 因农村，种族，种族和社会经济而因创伤死亡率的差异仍然很普遍。有一个 立即需要了解各种农村和其他各种各样的创伤相关差距的原因 服务不足的人群。我们建议系统科学以了解 与创伤相关的差距，并确定农村和其他服务不足人群的高影响力干预措施。 我们的长期研究目标是使用复杂的系统理论和仿真建模来设计，实施， 并评估系统级别的区域化创伤护理的变化，以改善人口健康并解决 健康差异。系统动力学是一种既定的建模方法，用于与 多重效应关系和反馈循环。在这个国家少数民族健康研究所 差异（NIMHD）R21提案，我们的短期目标是开发区域性的因果循环图 创伤系统通过对现有数据和关键利益相关者输入的次要分析告知。我们将创建一个 全面的数据集链接来自北卡罗来纳州EMS和院内创伤的现有全州数据 护理，创伤患者死亡率以及患者和社区人口统计以及社会经济状况。到 补充这些定量数据，我们将吸引区域创伤系统利益相关者和主题 具有定性系统动力学方法的专家。我们的具体目的是：（1）评估农村，种族种族， 北卡罗来纳州创伤患者的创伤分类和长期死亡的社会经济差异； （2）通过利益相关者为北卡罗来纳州的区域创伤系统创建因果循环图 参与以确定潜在的高影响干预措施以解决创伤差异。成功 这些目标的完成，我们将产生有关与创伤相关差异的基本初步数据 农村和其他亚组进行系统动态研究以了解和改善人口健康 和服务不足人群的护理质量。拟议的研究和我们的长期研究目标已经 对卫生系统建模产生重大科学影响的潜力，可以直接有助于改善 患有急性，威胁生命的疾病和伤害的患者的结果。