Brendan G. Carr, MD is an applicant for a Mentored Clinical Scientist Development Award. As of July 1, 2008, Dr. Garr will be an Assistant Professor of Emergency Medicine and Epidemiology at the University of Pennsylvania, School of Medicine. He has completed training in emergency medicine, epidemiology, trauma &surgical critical care, and health policy research. Dr. Carr's immediate goals are to expand his training in advanced health services research, geographical analysis, and systems theory. This will serve as a basis for an independent research program linking the design of the emergency care system to improved patient outcomes. He has assembled a mentoring team including national leaders in trauma care, health services research, and epidemiology. The proposed work seeks to improve understanding of how prehospital time impacts outcomes from conditions that require prompt emergency care. Trauma is one such condition. The US trauma care system has been recognized by the Institute of Medicine as a model of regionalized emergency care delivery and will serve as the focus of this analysis.
The specific aims are: (1) to produce valid estimates of prehospital travel time, (2) to complete the first nationally representative analysis of the effect of trauma center hospitals on injury mortality, and (3) to investigate the impact of prehospital time on the relationship between trauma centers and injury mortality.
These aims will be accomplished by first calculating estimated prehospital times using prehospital driving speeds and distances from patients to hospitals that will be compared to actual times recorded by state trauma registries. Next, data from the Nationwide Inpatient Sample database will be linked to trauma center level to analyze the impact of trauma center level on outcomes. Finally, prehospital time estimates will be incorporated into the model. An improved understanding of the role of prehospital time and trauma center level on patient outcomes will inform trauma care management decisions and ultimately support policy decisions to optimize the design of the emergency care system. In parallel, the applicant will emerge as a national leader able to conduct the research needed to further inform these policies and translate evidence into practice.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
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Anderson, Kay
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University of Pennsylvania
Emergency Medicine
Schools of Medicine
United States
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Carr, Brendan G; Bowman, Ariel J; Wolff, Catherine S et al. (2017) Disparities in access to trauma care in the United States: A population-based analysis. Injury 48:332-338
Aparicio, Hugo J; Carr, Brendan G; Kasner, Scott E et al. (2015) Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers. J Am Heart Assoc 4:e001877
Mullen, Michael T; Branas, Charles C; Kasner, Scott E et al. (2015) Optimization modeling to maximize population access to comprehensive stroke centers. Neurology 84:1196-205
Salhi, Rama A; Edwards, J Matthew; Gaieski, David F et al. (2014) Access to care for patients with time-sensitive conditions in Pennsylvania. Ann Emerg Med 63:572-9
Mullen, Michael T; Wiebe, Douglas J; Bowman, Ariel et al. (2014) Disparities in accessibility of certified primary stroke centers. Stroke 45:3381-8
Band, Roger A; Salhi, Rama A; Holena, Daniel N et al. (2014) Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med 63:608-614.e3
Clement, R Carter; Carr, Brendan G; Kallan, Michael J et al. (2013) Volume-outcome relationship in neurotrauma care. J Neurosurg 118:687-93
Myers, Sage R; Salhi, Rama A; Lerner, E Brooke et al. (2013) A pilot study describing access to emergency care in two states using a model emergency care categorization system. Acad Emerg Med 20:894-903
Myers, Sage R; Branas, Charles C; French, Benjamin C et al. (2013) Safety in numbers: are major cities the safest places in the United States? Ann Emerg Med 62:408-418.e3
Branas, Charles C; Wolff, Catherine S; Williams, Justin et al. (2013) Simulating changes to emergency care resources to compare system effectiveness. J Clin Epidemiol 66:S57-64

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