Committee on Military Care s Learning Health System and It s Translation into the Civilian Sector

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1 Committee on Military Care s Learning Health System and It s Translation into the Civilian Sector Leadership and Accountability David B. Hoyt, MD, FACS Executive Director American College of Surgeons Chicago, Il

2 What is your vision for an optimal trauma care system in the United States? Question 1

3 The Hoover Commission Secretary of Commerce - Reviewed the mortality crisis with the automobile 20,000 deaths/year Recommendations Roads, traffic safety, licensing No call for care systems

4 Trauma Magnitude of the Problem Most common cause of death 0-50 More years of life lost Cancer, heart disease, stroke The neglected epidemic

5 Traditional View: Trauma Care System the locally coordinated approach swift identification of injured persons transportation to optimal care Trauma Care Systems, CDC 1992 An organized response to injury

6 State or County Jurisdiction Goals: Public private partnership Use the public health model Policy development Assessment Assurance

7 Trauma Systems Model 1. Standards 2. Build Infrastructure 3. Measure performance data 4. Verification- public assurance Paramedic Training Regional EMS systems Access ATLS Evidence based Trauma Care standards Verification National Trauma Data Bank Population Disease Management Model Payer Blind

8

9 The Evidence 8-10% mortality reduction

10 Who controls/drives trauma care capabilities at the trauma system level and how does that get translated into a larger system of systems (i.e., the trauma system of the United States)? Question 2

11 Trauma System Plan West/Bazolli Criteria 2001 Authority to designate, certify, identify or categorize trauma centers Existence of a formal process to designate or otherwise identify trauma centers Use of ACS standards to designate/identify trauma centers Inclusion of on-site verification during the designation/identification process and the use of outside-of-area surveyors Authority to limit the number of trauma centers based on need for trauma services Existence of prehospital triage protocols for trauma patients Existence of a process for monitoring trauma center performance Statewide coverage of trauma system

12 Why Not Everywhere HRSA 2006

13 Updated June 2015 Trauma Systems Evaluation and Planning Committee Consultations and Facilitations AK 2008 Marin County 2002 Alameda County HI 2005 Solano County CA Ventura County 2010 OR WA NV Clark County 2004, 2011 ID UT 2005 Navajo Nation AZ Regional Consultations Pending MT 1999 WY 2004 CO 2009 NM ND 2008 SD NE KS 2008, 2014 TX OK MN 2007 Southwest Region 2005 IA MO 2009 AR 2011 LA 2009 WI 2011 IL 2006 MS IN OH Tri- State 2002 KY TN 2008 AL MI GA 2008 WV PA 2007 VA BIS 2005 NC 2004 SC 2014 FL 2013 NY VT NH ME MA 2012 RI 2004 CT 2006 NJ 2008 DE D.C MD Completed Trauma System Consultation Scheduled Trauma System Consultation Tentative Trauma System Consultation Benchmarks, Indicators, and Scoring Facilitation Completed

14 Durability of Elements Study 2015 Average Indicator Change 3-9 years out

15 Question 3 What actions can be take to improve the translation of military lessons learned to the civilian sector (e.g., tourniquets) and vice versa? What mechanisms would address the gaps in translation of military lessons to the civilian sector?

16 Military Health System Strategic Partnership with the American College of Surgeons Quality collaborative Education and Readiness Joint Trauma System assessment Clinical Trials using clinical registries and trauma hospital networks

17 EMS/fire agencies 194 hospitals Greater than 100 IRBs 36,000 EMS/fire personnel Population of 24 million

18 Resuscitation - 11 years $85 million Should we resuscitate Ringer s lactate and NS HTS Field lactate monitoring Hemoglobin solutions Blood reconstitution Estrogen adjuvants TXA treatment

19

20 Question 4 Where is trauma care in the context of health reform? How does the trauma care perspective get integrated into health delivery reform processes?

21 HR 647 Access to Life Saving Trauma Care A Provides federal funding to help cover uncompensated costs in trauma centers.. HR 648 Trauma Systems Regionalization Reauthorizes Trauma Care Systems Planning Grants - Support state and rural development of trauma systems - pilot projects liability protections for physicians providing EMTALA mandated care. HR 865 Good Samaritan Health Professionals liability protections for volunteers in a declared disaster

22 Question 5 ACS is leading national efforts to create an infrastructure for ensuring adoption of best practices in trauma care. What should be done to build this capacity and capability across the United States and eliminate geographic variability in quality of trauma care?

23 Solutions Complete system with federal oversite Matching grants Utilize ACS consultation expertize Get to vulnerable areas needs based designation Emphasize private public partnership August 24 th -25 th 2015

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