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Abstract #160997

Munseok Seo and Charles E. Begley. Management, Policy, and Community Health, University of Texas School of Public Health, 1200 Herman Pressler, RAS E-333, Houston, TX 77030, 832-630-9275, munseok.seo@uth.tmc.edu

Objective: We will review one year of Texas hospital discharge data and trauma registry data for the 22 trauma services regions around Texas to determine what regional variations exist in the capacity, process and clinical outcomes for trauma patients and whether there is an association between capacity, process, and outcomes. Methods: ICD9-CM codes (800-959) and ICD/ISS Injury Severity Score(ICD/ISS>15) will be used to select all injured patients and major trauma via ICDMAP-90 software. The indicators for capacity are: staffed beds per capita of the designated trauma centers including Level I to IV. The indicators of process are: ambulance transport hours; over/undertriage; and interhospital transfer hours. The indicators of outcomes are: trauma mortality; hospital/ICU LOS; and hospital costs. Analysis: Data analyses are described by descriptive statistics to examine regional variations in capacity, process, and outcomes. Hierarchical structure are composed of the 3 different levels: Level 1(trauma patients); Level 2 (trauma centers); and Level 3(regions). One-way ANOVA random effects models will be used to test the regional variability at the 5% significance level. Multivariate regression analyses will be used to test the relationships between capacity, process, and outcomes measures. A likelihood ratio test will be used to determine the significance of variances which represent the regional variations for continuous response variables (hospital/ICU LOS and hospital care cost). For discrete response variable (trauma mortality), a Wald test will be used. The p-value will be used to examine whether the null hypothesis of each model will be rejected at the 5% level. Other covariates such as age, gender, ISS and insurance status will be considered in the models to adjust for the confounding effects. Results: We expect that there will be statistically significant differences between the regions in terms of capacity, process, and outcomes. The regions with the highest number of ratios or averages in the indicators such as staffed beds per capita, transport/transfer hours, over/undertriage, trauma mortality, hospital/ICU LOS and hospital costs will be in the metropolitan areas. We expect that the regions with more staffed beds per capita will have lower trauma mortality, shorter hospital/ICU LOS, and lower hospital costs. Also, the regions with less transport hours, transfer hours, and lower under/over-triage will have lower trauma mortality, shorter hospital/ ICU LOS, and lower hospital cost. Conclusions: The regional variations in capacity measures (staffed beds per capita) will be a critical contributor to make regional differences in process and outcomes for trauma patients.

Learning Objectives:

• I, who would like to be a prospective health services researcher, am sure to obtain the better research skills including the scientific writing and creative study design via participating in submitting to the APHA meeting. Assessing the performance of the regionalized trauma system I am applying to my research purpose is possible through developing measures of capacity, process, and clinical outcomes originated in health services delivery system. The clinical outcomes of this study mean the morbidity, mortality, length of stay of hospital and ICU, and hospital costs caused by injury. The results the study find is expected to be used for the regional trauma related decision makers to reduce trauma related morbidity, mortality, and costs which occurred unnecessarily. The indicators the study use are staffed beds per capita as capacity measure, transfer/transport time in hours and over/undertriage rate as process measure, and mortality, morbidity, length of stay, and hospital costs as clinical outcomes. The comprehensive population based data (Texas hospital discharge data and Texas trauma registry data) supplied by Texas state is used to monitoring the trauma systems by regions.

Keywords: Risk Factors, Assessments

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.