Developing a Teletrauma Implementation Toolkit for Early Point-of-Care Delivery of Trauma Care Expertise to Injured RUral Patients

About This Grant

PROJECT SUMMARY / ABSTRACT Timely treatment after traumatic injury at specialized hospital units, known as trauma centers, reduces risk of death by 25%. But nearly 30 million rural U.S. residents – disproportionately from Black, American Indian/Alaskan Native and low-income populations – lack timely access to a trauma center, resulting in access-mediated disparities in injury outcomes. The traditional solution of establishing new trauma centers is slow, costly, and impractical in many rural areas. As a result, access to trauma care and clinical outcomes among injured rural patients have not improved in over a decade. A promising alternative solution is to use telehealth to remotely consult trauma care experts (i.e., teletrauma) at the time of an injured patient’s arrival to a rural emergency department (ED). While this form of provider- to-provider telehealth is well-established in several healthcare areas, the U.S. civilian trauma system severely underutilizes telehealth – in 2020, only 8% of U.S. EDs reported using teletrauma compared to 45% using telestroke. Echoing recent recommendations from the Agency for Healthcare Research and Quality (AHRQ) report on rural telehealth, the American College of Surgeons Committee on Trauma (ASC COT) has called for the creation of a teletrauma implementation toolkit to facilitate sustainable development of rural teletrauma programs. Given the time-sensitive, medically complex and multidisciplinary nature of trauma care, existing non-trauma telehealth toolkits cannot be readily used to implement teletrauma and need adaptation to trauma-specific contexts. Therefore, we propose to create a provider-to-provider teletrauma implementation toolkit to guide sustainable development of teletrauma programs for rural trauma care. We propose the following aims, in collaboration with the Coalition for National Trauma Research (CNTR), and with support from the American College of Surgeons Committee on Trauma (ACS COT), the American Association for the Surgery of Trauma (AAST) and the Eastern Association for the Surgery of Trauma (EAST). Aim 1: Identify and prioritize patient/injury characteristics feasible for provider-to- provider teletrauma. Using a mixed-methods approach, quantitative data from the Healthcare Cost and Utilization Project will inform a stakeholder advisory group (SAG)-led modified Delphi process to identify and prioritize a list of patient/injury characteristics feasible for provider-to-provider teletrauma use. Aim 2a: Adapt existing non-trauma telehealth toolkits into a teletrauma implementation toolkit. In collaboration with the SAG, we will use the ADAPT process and an intervention mapping approach with qualitative methods to identify and adapt suitable elements from existing, non-trauma telehealth toolkits to trauma-specific contexts. Aim 2b: Evaluate the feasibility, acceptability and usability of the teletrauma toolkit. We will conduct semi-structured interviews with trauma medical directors (TMDs) at trauma centers in rural trauma systems to evaluate the teletrauma toolkit. Impact: Our proposed study will lay the groundwork for wider implementation of teletrauma in the U.S. These results will support future research on the implementation and effectiveness of the teletrauma toolkit in improving injury care for rural disparities populations. Our collaboration with leading national trauma organizations will ensure wide dissemination.