S. Lin1, C. Johnson3, A. E. Liepert2 1Oregon Health And Science University,Surgery,Portland, OR, USA 2University Of Wisconsin,Surgery,Madison, WI, USA 3American College Of Surgeons,Division Of Advocacy And Health Policy,Washington, D.C., USA
Introduction: The implementation of trauma systems is a mainstay in American health care delivery resulting in many saved lives. It is regulated at the state level; however, a database of trauma system legislation and state funding sources has not been compiled in the medical literature. This absence reflects the disconnect physicians experience with legislative and regulatory processes, although they greatly impact the system of care they function within. This study attempts to compile trauma system regulations and funding sources in all 50 states to be used for Surgical Health Policy Advocacy in order to ensure adequate trauma care delivery and parity between and across states.
Methods: Department of Health offices of each state’s trauma system were contacted via email and telephone. Resultant trauma system data were categorized according to the ability to access trauma system funding data, the presence of a trauma system in the state code, the presence of state statutes addressing trauma funding, the amount of trauma funding and the sources of funding for each trauma system. Data for each group included whether information could be compiled for an individual trauma system, the presence of state statutes addressing creation of a trauma system, the presence of statutes specific to trauma system funding and the total amount in dollars to trauma systems when available. States that underwent ACS trauma systems consultation were also captured.
Results: This taxonomy of trauma system funding was obtained for 24 (48%) states. This was fully compiled in 8 (16%) states, partially compiled in 16 (32%) states and no accurate data was available in 26 (52%) states. Specific legislation creating a trauma system was identified in 43 (86%) states. No direct legislation of the formation of a trauma system was found in 5 (10%) states. 2 (4%) states do not have legislation creating a trauma system. 18 (36%) states have legislation directly funding their trauma systems, 4 (8%) states have legislation regarding trauma funding. No trauma system funding data was located in 28 (56%) states. Financial contributions ranged from $315,000 in Minnesota in 2011-2012 to $25,899,450 in Arkansas in 2016-2017. ACS Trauma Consultations took place at least once in 33 (66%) states. No correlation between states with these consultations and presence of trauma funding legislation was noted.
Conclusion: This study demonstrates the difficulty of acquiring legislative information for use in Surgical Health Policy Advocacy efforts. It emphasizes the need for the development of tools to be used to summate and disseminate comprehensive and comparative legislative data and information. Future work to compile data such as this will aid in surgeon led legislative and regulatory advocacy efforts and improve not only systems as a whole but ultimately patient care.