Mitigating Injury Disparities with Evidence Based Trauma Systems Planning

通过基于证据的创伤系统规划来减轻伤害差异

基本信息

批准号：
10786608
负责人：
Molly Price Jarman
金额：
$ 91.64万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-24 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10786608
关键词：
Address Algorithms American College of Surgeons Biological Models Black race Caring Case Study Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Clinical Consensus Data Disparity Disparity population Dissemination and Implementation Emergency medical service Engineering Equity Ethnic Population Future Geographic Locations Geography Goals Hispanic Hospitals Human Resources Improve Access Incidence Infrastructure Injury Intervention Interview Knowledge Life Link Literature Low Income Population Low income Maryland Measures Mediating Mediation Medical Medicine Methods Modeling Nurses Operative Surgical Procedures Outcome Pathway interactions Patients Persons Physician Executives Policy Maker Population Process Protocols documentation Recommendation Reduce health disparities Reporting Resource Allocation Resources Risk Reduction Rural Sampling Series Signal Transduction Source Structure Surveys System Testing Time Transportation Trauma Trauma Research Trauma patient Traumatic injury Triage United States Agency for Healthcare Research and Quality United States National Academy of Sciences Work access disparities black patient care systems cost disparity elimination disparity reduction effectiveness evaluation evidence base health disparity populations improved outcome injury burden marginalization mortality mortality risk outcome disparities prevent programs racial population response rural dwellers secondary outcome severe injury standard care trauma care trauma centers trend

项目摘要

Traumatic injuries caused more than 200,000 deaths and the loss of 2 Million potential life years in the US in 2019. Black, Hispanic, rural, and low-income populations bear a disproportionate burden of injury incidence and mortality. There is an increasing body of evidence suggesting systematic inequities in access to trauma care are a substantial driver of these injury disparities, but current evidence does not identify or quantify specific system-level interventions that might reduce health disparities. We propose the following aims to identify strategies to mitigate disparities in trauma outcomes: Aim 1: Examine approaches to trauma system planning in states without disparities in trauma outcomes. We will conduct a series of in-depth case studies with a purposive sample of state trauma systems (n=10) identified based on injury mortality trends from 2000-2020. Using document review and semi-structured interviews with stakeholders responsible for trauma system planning in each state (e.g., medical directors, nurse managers), we will examine the overall approach to trauma system planning, and specifically probe for planning decisions intended to address disparities. Aim 2: Identify modifiable trauma system characteristics associated with injury disparities and decompose the structural pathways causing injury disparities. We will conduct a national survey of state trauma systems to identify existing trauma system resources (e.g., infrastructure, personnel), then link survey responses with outcomes data from the Centers for Disease Control and the Agency for Healthcare Research and Quality. After identifying trauma system characteristics associated with injury outcomes among disparities populations, we will use mediation pathway models to decompose the effects of trauma system resource allocation as a determinant of injury disparities. Aim 3: Identify and prioritize strategies to mitigate injury disparities through trauma system planning and resource allocation. We will conduct a Delphi consensus panel with national stakeholders, in partnership with the Coalition for National Trauma Research (CNTR). We will ask panelists to evaluate and prioritize recommendations trauma system interventions to mitigate disparities, drawing from the results of Aims 1 and 2, and from the literature. Impact of proposed work: Our proposed work will facilitate equity in trauma care by contextualizing current approaches to trauma systems planning, identifying specific trauma care resources that mediate injury disparities, and identifying actionable strategies to address disparities at the trauma system level. Our partnerships with national trauma leaders will support dissemination and implementation throughout the US.

2017 年，美国因创伤性伤害导致超过 20 万人死亡，并损失了 200 万潜在生命年。 2019.黑人、西班牙裔、农村和低收入人群承受着不成比例的伤害发生率负担和死亡率。越来越多的证据表明在获得创伤方面存在系统性不平等护理是这些伤害差异的重要驱动因素，但目前的证据并未确定或量化可能减少健康差距的具体系统级干预措施。我们提出以下目标确定减少创伤结果差异的策略：目标 1：检查各州创伤系统规划方法没有差异结果。我们将通过国家创伤系统的有目的地样本进行一系列深入的案例研究 (n=10) 根据 2000-2020 年伤害死亡率趋势确定。使用文档审查和半结构化与各州负责创伤系统规划的利益相关者进行访谈（例如医疗主任、护士经理），我们将检查创伤系统规划的总体方法，并特别探讨旨在解决差异的规划决策。目标 2：确定与损伤差异相关的可改变的创伤系统特征分解导致损伤差异的结构途径。我们将进行全国州调查创伤系统识别现有的创伤系统资源（例如基础设施、人员），然后链接调查使用疾病控制中心和医疗保健研究机构的结果数据进行回应和质量。在确定与损伤结果差异相关的创伤系统特征后人群，我们将使用中介路径模型来分解创伤系统资源的影响分配作为伤害差异的决定因素。目标 3：通过创伤系统规划确定并优先考虑减轻伤害差异的策略和资源分配。我们将与国家利益相关者合作召开德尔福共识小组与国家创伤研究联盟 (CNTR) 合作。我们将要求小组成员进行评估并确定优先顺序根据目标 1 和目标 1 的结果，建议采取创伤系统干预措施来缩小差距 2、来自文献。拟议工作的影响：我们拟议的工作将通过结合当前的背景来促进创伤护理的公平性创伤系统规划方法，确定介导伤害的特定创伤护理资源差异，并确定可行的策略来解决创伤系统层面的差异。我们的与国家创伤领导人的合作将支持在美国各地的传播和实施。