Performance-Based Assessment of Trauma Systems: Estimates for the State of Ohio

Abstract

Objectives

There are no widely accepted metrics to determine the optimal number and geographic distribution of trauma centers (TCs). We propose a Performance-based Assessment of Trauma System (PBATS) model to optimize the number and distribution of TCs in a region using key performance metrics.

Methods

The proposed PBATS approach relies on well-established mathematical programming approach to minimize the number of level I (LI) and level II (LII) TCs required in a region, constrained by prespecified system-related under-triage (srUT) and over-triage (srOT) rates and TC volume. To illustrate PBATS, we collected 6002 matched (linked) records from the 2012 Ohio Trauma and EMS registries. The PBATS-suggested network was compared to the 2012 Ohio network and also to the configuration proposed by the Needs-Based Assessment of Trauma System (NBATS) tool.

Results

For this data, PBATS suggested 14 LI/II TCs with a slightly different geographic distribution compared to the 2012 network with 21 LI and LII TC, for the same srUT≈.2 and srOT≈.52. To achieve UT ≤ .05, PBATS suggested 23 LI/II TCs with a significantly different distribution. The NBATS suggested fewer TCs (12 LI/II) than the Ohio 2012 network.

Conclusion

The PBATS approach can generate a geographically optimized network of TCs to achieve prespecified performance characteristics such as srUT rate, srOT rate, and TC volume. Such a solution may provide a useful data-driven standard, which can be used to drive incremental system changes and guide policy decisions.

Keywords

trauma center distribution health care quality access and evaluation health policy resource allocation delivery of health care Needs-Based Assessment of Trauma System

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