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Principal Investigator: Bryant Oliphant
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $93,758
Funding agency: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Project Summary
More than 345,000 patients are treated for a lower extremity injury (LEI) each year at trauma centers (TC) in
the United States. This represents a substantial societal burden both in the direct treatment costs and the
indirect costs due to lost work. These injuries are often painful, require considerable treatment interventions
and have the potential to cause long term disability. The most optimal place to treat LEI is at a TC due to the
required resources, staff expertise and coordination of care. However, TC capabilities vary based on certain
criteria, both structural (e.g. physical resources, provider skillsets) as well as process (e.g. intervention times).
This variation in capabilities is displayed by the TC level designation, from I (complete comprehensive care) to
III (assessment and stabilization), which often serves as a basic framework to guide triage and transfer
decisions for treatment. However, little research has been performed to date examining whether these
designations can or should be used for this purpose, since they are mostly based on “expert opinion” rather
than data. It is unknown if the criteria that are used for TC level designation are really appropriate to achieve
the best outcomes in patients with LEI. Capitalizing on the unique data infrastructure in the state of Michigan,
with rich trauma registry, cost and utilization data, this proposal will evaluate patients with LEI from the time of
their initial injury through their treatment course and will explore the factors important for delivering high value
care. The specific research aims are to evaluate: (1) short and long-term outcomes in patients with LEI across
TCs (2) the differences in overall episode spending and treatment efficiencies in patients with LEI at across
TCs (3) the characteristics of TCs that drive high quality efficient care of LEI patients. This will be the first
population-based evaluation of LEI that will follow patients throughout their continuum of care. This is possible
because of the innovative approach of linking datasets together to capture vital post-discharge information
which is essential for tracking orthopaedic outcomes (e.g. infection, malunion and nonunion) that occur in the
weeks and months after injury. Further, by examining the structures and processes at TCs, this study will have
the immediate impact of identifying the key characteristics that are important in driving optimal efficient care.
This research proposal, the highly experienced multidisciplinary mentorship team and the unparalleled
research environment will address the career goals and educational needs of the candidate, Bryant Oliphant,
MD, MBA, MSc. The proposal includes a detailed educational plan that will guide the successful completion of
this research and the development of Dr. Oliphant’s career as a health services researcher and leader in
trauma policy. The training includes graduate level courses in health care delivery systems, quantitative
methods as well as a hands-on approach to understanding the interplay of research with policy. This career
development award will lay the groundwork for Dr. Oliphant to become an independent clinician scientist who
performs innovative health services research and is a leader in improving trauma care in this country.
Terms: <Address><Affect><Automobile Driving><Awareness><Career Development Awards><Career Development Awards and Programs><Career Development Programs K-Series><Caring><Characteristics><Clinical><Comprehensive Health Care><Comprehensive Healthcare><Continuity of Care><Continuity of Patient Care><Continuum of Care><Country><Data><Data Set><Development and Research><Durable Medical Equipment><Economic Burden><Education><Educational aspects><Environment><Essential employee><Essential person><Essential personnel><Essential staff><Essential worker><Evaluation><Expert Opinion><Facilities and Administrative Costs><Feedback><Goals><Guidelines><Health Services><Health Services Evaluation><Health Services Research><Health system><Healthcare Delivery><Hospitals><Human Resources><Indirect Costs><Individual><Infection><Injury><Inpatients><Intervention><Intervention Strategies><Interview><Investigators><K-Awards><K-Series Research Career Programs><Knowledge><Lead><Length of Stay><Link><Long term disability><Long-term Follow-up><Longterm Follow-up><Lower Extremity><Lower Limb><Manpower><Medical><Medical Care Research><Medical Rehabilitation><Membrum inferius><Mentorship><Methods><Michigan><Minor><Number of Days in Hospital><Orthopedic><Orthopedic Surgery><Orthopedic Surgical Profession><Orthopedics><Outcome><Pain><Painful><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pb element><Physiatric Procedure><Physical Medicine Procedure><Physical Therapeutics><Physical therapy><Physiotherapy><Policies><Process><Provider><R & D><R&D><Registries><Rehabilitation><Rehabilitation therapy><Research><Research Career Program><Research Personnel><Research Proposals><Research Resources><Researchers><Resources><Risk Adjustment><Scientist><Severities><Site Visit><Structure><Surgeon><System><Time><Training><Trauma><Treatment Cost><Triage><United States><Variant><Variation><Work><care coordination><care episode><care for patients><care of patients><career><caring for patients><co-morbid><co-morbidity><comorbidity><comprehensive care><coordinating care><cost><data infrastructure><data registry><demographics><driving><education planning><experience><extremity injury><extremity trauma><health and care delivery><health care delivery><health delivery systems><health services delivery><heavy metal Pb><heavy metal lead><hospital days><hospital length of stay><hospital stay><improved><improved outcome><injuries><injury to extremity><innovate><innovation><innovative><interventional strategy><limb injury><limb trauma><long-term followup><longterm followup><methods to study multiple-level influences><multi-level analysis><multi-level model><multidisciplinary><multilevel analysis><multilevel model><multilevel modeling><patient oriented outcomes><personnel><population based><precision medicine><precision-based medicine><programs><rehab therapy><rehabilitative><rehabilitative therapy><research and development><services research><skills><tertiary care><trauma care><trauma centers>