Trauma is a leading cause of death and disability, and also a major contributor to health disparities of those who are elderly, low-income, racial minorities, and reside in urban or rural regions. In order to improve quality of care at trauma centers, the American College of Surgeons Committee on Trauma (ACS-COT) developed the Trauma Quality Improvement Program (TQIP). TQIP collects data from all ACS-verified trauma centers and provides risk-adjusted outcome reports, benchmarked against national averages. The program identifies at-risk populations within hospitals, specifies hospital characteristics associated with patient risk, and facilitates dissemination of best practices among the participating trauma centers. These measures have been associated with significant improvements in trauma patient outcomes. While TQIP provides substantial support to trauma centers, many trauma patients initially present to non-trauma hospitals. In Indiana, for example, the majority (55 percent) of trauma patients received their initial care at non-trauma hospitals, yet no program currently exists to examine outcomes and promote quality improvement at these facilities. Ideally, healthcare providers at such hospitals identify life-threatening injuries, provide initial resuscitation, and rapidly transfer patients to highly specialized trauma centers. The ability of non-trauma hospitals to meet those objectives, however, may be limited by geographic factors, resource constraints, and a lack of clinical expertise. As a result, non-trauma hospitals may harbor variation in quality of trauma care and disparities in health outcomes among their patient populations. Therefore, on-going analysis of non-trauma hospital outcomes and the promotion of best practices represents a critical need within the trauma system. My overall research goal is to optimize the coordination of care and outcomes of severely injured patients within a regionalized system of trauma care. Through this diversity supplement, my training goals are to acquire expertise in implementation research strategies specific to non-trauma hospitals with a focus on 1) stakeholder-centered, qualitative research methodologies; 2) improvement and implementation research methodologies; and 3) program development and maintenance. I seek to accomplish these goals through the following Specific Aims: (1) Engage stakeholders to identify key outcomes associated with optimal quality in trauma care at non-trauma hospitals to inform a modified TQIP process; (2) Develop a dissemination and implementation (D&I) toolkit to facilitate ETQIP-directed quality improvement initiatives that promote optimal trauma care at non-trauma hospitals; and (3) Pilot E-TQIP to evaluate the acceptability and feasibility of the program. Along with the expertise of my multi-disciplinary mentoring team, the Research Plan proposed in this application will prepare me to obtain R01 funding to support the statewide implementation of E-TQIP to measure its influence on the outcomes of this vulnerable patient population.
Despite the substantial resources that have been invested in the advancement of trauma care at U.S. trauma centers, the majority of injured patients still received their care at non-trauma, hospitals ? hospitals that receive no such support for improvements in trauma care. The work detailed in this proposal seeks to provide the foundational research necessary for the expansion of the current U.S. trauma system to include outreach to and quality improvement for those hospitals. To achieve these goals, the work includes broad stakeholder engagement, and it utilizes a progressive human-centered approach to program design and implementation.
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