Altman DF, Levitt L, Lewis F, Shaghoury C; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 52-3.
The Lewin Group, San Francisco, CA 94105, USA.
RESEARCH OBJECTIVE(S): To 1) develop a model which would predict the demand for trauma services in a community based on an assessment of current utilization as well as projections of population and incidence of trauma; and 2) assess optimal resource configurations to meet projected demand. STUDY DESIGN: We assessed current and future regional trauma service demand based on the current number of admissions to designated trauma services in the region, projections of pouplation growth by county and, in populous areas, by zip code, and projections of motor vehicle inujuries and crime victimization. Using a qualify-of-care medical audit, we assessed current trauma care practices with regard to the appropriateness of field triage criteria and decisions to admit patients to the hospital from the emergency room. Projected volumes of trauma service admissions in five and ten years were compared to established standards of the minimum and optimal number of patients seen by a trauma surgeon and by a trauma service in order to maintain quality of care. Finally, benchmarking data were obtained from multiple established trauma systems in various regions in the United States. PRINCIPAL FINDINGS: In a county with a population of 1.13 million people, of the almost 7,000 patients being brought to trauma center emergency 55% were admitted to the hospital and of those 45% were "major trauma patients" as defined by mortality, requirement of surgery or intensive care, or length of stay greater than or equal to three days. Whereas the population of the region was projected to grow at a rate of 2.04 percent per year for the next ten years, the projected number of admissions to trauma services was projected to grow by 19 percent during the entire period. In addition, the elimination or modification of certain field triage criteria, identified in the audit as being associated with low morbidity, could reduce future demand by a minimum of 10 percent. Given the current standards for trauma service volume related to quality of care, two fully staffed trauma units should be sufficient to meet the demnad for these services for the next ten years and beyond. CONCLUSIONS: Using publicly available data sources and employing established medical audit techniques, community-wide assessment of trauma service demand can provide guidance in deciding the optimum configuration of these costly patient care services. In addition, this mechanism can be used to judge prospectively the impact in changes in local trauma systems such as changes in trauma triage criteria. RELEVANCE TO CLINICAL PRACTICE AND POLICY: The designation of hospitals as trauma centers remains an important health policy functions for the local and state governments. The designation of a center can have important implications for a community's health care costs and quality. Recent reports suggest that over-designation of trauma centers may be a problem in many communities. This unique study developed tools which would be of great use in such considerations in many areas of the United States.
Publication Types:
Keywords:
- Evaluation Studies
- Forecasting
- Hospitals
- Humans
- Incidence
- Physical Examination
- Trauma Centers
- Triage
- United States
- injuries
- instrumentation
- methods
- supply & distribution
- hsrmtgs
Other ID:
UI: 102233488
From Meeting Abstracts