Long-term Trauma Outcomes and Insurance Policy

PROJECT SUMMARY/ABSTRACT Though trauma is often considered an isolated disease process, advancements in acute care have shifted the burden of injury from the acute physiologic insult to the chronic post-injury sequalae. Over 95% of hospitalized trauma patients now survive to discharge. However, many go on to suffer long-term consequences of injury in

the form of worsened functional status, mental health, and health-related quality of life. These trauma-initiated chronic conditions make it difficult for many working-age adults to return to work and economic productivity. The combination of poor clinical outcomes and work loss may be further compounded by unexpected medical

debt as many working-age adults carry high-deductible insurance plans. Unfortunately, there is a paucity of information regarding long-term clinical and economic outcomes after major injury in the US. As a result, the policy interventions needed to optimize long-term recovery after major injury remain unknown. The purpose of

this proposal is to close these key knowledge gaps and map a policy response moving forward. The specific research aims of this proposal are to evaluate (i) long-term clinical outcomes and (ii) long-term economic outcomes among working-age survivors of traumatic injury; and to evaluate (iii) the impact of alternative

insurance design strategies on long-term outcomes after traumatic injury. The proposed study leverages a unique data opportunity at our institution and will be the first of its kind to combine a state-wide trauma registry (containing both inpatient data and long-term patient-reported outcomes) with 24 months of pre-injury and 24

months of post-injury consumer credit reports. We will use the evidence from these novel analyses to simulate changes in insurance benefit design in order to optimize return to work and mitigate financial strain after injury. This project will also facilitate the career development of the candidate. The highly experienced and

multidisciplinary mentorship team, the proposed career development and research plan, and the unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate PI, John W. Scott, MD, MPH. Although he has substantial prior experience in surgical health services research, he

lacks experience with (i) longitudinal data analysis, (ii) evaluating personal financial data, and (iii) policy simulation methods. In addition to the innovative research plan, this proposal also includes additional training which will be essential both for the successful completion of this research and for Dr. Scott’s career

development, including graduate level courses and experiential learning opportunities. This career development award will lay the groundwork for Dr. Scott to mature as an independent investigator and national leader in improving long-term clinical and economic outcomes after acute illness and injury through policy

evaluation and reform.