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

• 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
• 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

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.

创伤性伤害造成了200,000多人的死亡，在美国损失了200万个潜在的生命年。 2019年。黑人，西班牙裔，农村和低收入人群承担不成比例的伤害发病率 和死亡率。有越来越多的证据表明有系统的不平等现象可获得创伤 护理是这些伤害差异的实质性驱动力，但目前的证据无法识别或量化 特定的系统级干预措施可能会降低健康差异。我们建议以下目标 确定减轻创伤结果差异的策略： 目的1：检查在没有创伤差异的州的创伤系统计划的方法 结果。我们将使用有目的的状态创伤系统样本进行一系列深入的案例研究 （n = 10）根据2000 - 2020年的损伤死亡率趋势确定。使用文档审查和半结构 与负责每个州创伤系统计划的利益相关者的访谈（例如，医疗董事， 护士经理），我们将研究创伤系统计划的总体方法，特别是对 计划决定旨在解决差异。 目标2：确定与伤害差异相关的可修改创伤系统特征 分解导致损伤差异的结构途径。我们将对国家进行全国调查 识别现有创伤系统资源（例如基础设施，人员）的创伤系统，然后链接调查 来自疾病控制中心和医疗保健研究机构的结果数据的响应 和质量。在确定了与差异之间的伤害结果相关的创伤系统特征之后 人群，我们将使用调解途径模型分解创伤系统资源的影响 分配是伤害差异的决定因素。 目标3：通过创伤系统计划确定并确定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进行Delphi共识小组 与国家创伤研究联盟（CNTR）。我们将要求小组成员评估和优先级 从目标1和 2，以及文学。 拟议工作的影响：我们提出的工作将通过将当前的情况下下文化来促进创伤护理的公平性 创伤系统计划的方法，确定介导伤害的特定创伤护理资源 差异，并确定可行的策略以解决创伤系统级别的差异。我们的 与国家创伤领导人的伙伴关系将支持整个美国的传播和实施。