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

紧急创伤护理中的健康公平：院前紧急创伤护理系统的差异分析

基本信息

批准号：
10594244
负责人：
Cherisse D. Berry
金额：
$ 66.45万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
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：
2023-07-13 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10594244
关键词：
Acquired Immunodeficiency Syndrome Address Adult African American population American Area Automobile Driving Black race Caring Cause of Death Cessation of life Child Data Data Science Database Management Systems Databases Disparity District of Columbia Emergency Care Emergency Situation Emergency medical service Enrollment Equity Ethnic Origin Geography Goals Health Health Services Accessibility Hospitals Information Sciences Information Systems Inpatients Insurance Coverage Intervention Knowledge Life Measurable Measurement Methods Minority Groups Modeling Morbidity - disease rate Neighborhoods Outcome Patient-Focused Outcomes Patients Persons Phase Policies Policy Developments Population Poverty Public Health Race Reaction Time Research Role Socioeconomic Factors Socioeconomic Status Stroke System Testing Time Transportation Trauma Trauma patient Traumatic injury United States aged care systems cohort deprivation design disparity elimination disparity reduction ethnic minority population experience health care service health disparity health equity health inequalities high risk improved improved outcome indexing injured intervention effect mortality mortality risk novel predictive modeling prevent programs public health insurance racial minority population segregation severe injury social health determinants spatial epidemiology spatiotemporal therapy design time use trauma care trauma centers

项目摘要

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.

项目概要/摘要创伤是 46 岁及以下儿童和成人死亡的主要原因，导致更多美国人死亡比艾滋病和中风的总和还多。非裔美国人（OR 1.2，P<0.001），生活在高度贫困中的人社区（OR 1.01，P<0.001），以及参加公共健康保险计划的人（OR 1.53，与受伤的同伴相比，创伤后的死亡率增加（P<0.001）。量化获得紧急医疗服务 (EMS) 和指定/验证的创伤中心 (TC) 的公平性，以及及时获得护理在多大程度上改善健康结果是解决这一问题的关键第一步这种令人震惊的差异。 EMS 的公平可用性尚未得到评估，TC 的公平获取也有待评估待研究。事实上，没有人探讨过快速提供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素的作用的模型尚未经过测试。迅速的运送到 TC 可使死亡率降低 25%；然而，近 4500 万美国人缺乏及时访问经过验证的 TC。与白人相比，最近的数据显示少数族裔/族裔人群获得 TC 的机会明显减少，并且创伤后的结果更差。理解决定创伤相关社会空间差异的因素可以为政策干预提供信息和系统层面，以减轻少数族裔所经历的不成比例的大量死亡人口。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改善患者的治疗效果。评估 EMS 和服务的可用性和获取方面的社会空间差异对于重伤创伤患者的TC，我们将应用健康公平可衡量框架（HEMF）紧急创伤护理系统的院前阶段（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 TC 与非 TC 以及 EMS 总计院前时间）并使用大型国家数据库开发时空模型来评估驱动因素外伤的差异。 HEMF 特别适合我们提出的研究，因为它旨在在因果框架中描述 SDOH，以指导健康公平性的定量分析对重伤者持续进行院前创伤护理监测并制定后续政策。我们的跨学科团队将使用数据科学方法和新颖的分析来解决这一关键的公共卫生问题通过确定院前紧急创伤护理系统层面的健康差异来满足需求。