O. Mansuri1, R. Lingnurkar2, A. Costas-Chavarri3 1Central Michigan University College Of Medicine,Trauma & Surgical Critical Care,Saginaw, Michigan, USA 2University of Missouri – Columbia,Hugh E. Stephenson Jr., MD, Department of Surgery,Columbia, Missouri, USA 3Harvard Medical School,Rwanda Military Hospital,Kigali, RWANDA, Rwanda
Introduction:
There is growing competition to become a trauma center and renewed interest in the designation and verification processes.There are significant public policy considerations with regards to this and the impact on volume, quality, and outcomes. The distinction between state designation as a matter of local policy and verification as administered by the American College of Surgeons is at the center of this issue. In this mixed-methods primary qualitative study we examine the variance of designation vs. verification in trauma centers with the goal of better understanding the phenomenon of trauma center growth and how best to regulate it in the interest of optimal care of the injured patient.
Methods:
The ACS trauma center database was queried by state and all ACS verified adult trauma programs were logged in inventory format. The state designation authorities were also queried and all state designated trauma centers were similarly logged. Also was noted when the state designation process relied on principal ACS verification as a condition for designation or whether the state maintained its own independent process. The variance was then examined qualitatively against the source of new trauma programs and analyzed for market penetrance. This was evaluated in the context of public policy impact as seen by the issue becoming part of the local public discourse.
Results:
The state designation models ranged from prequalification requirement of ACS verification to complete independence from the formal ACS verification process. Many states utilized the ACS verification process for level 1 and level 2 designations but maintained their own processes for level 3, 4, and 5 designations. The data suggests that states that did not have ACS verification as requirements for designation found higher rate of market entry, often at levels 2 and 3 as did states that auto-designated based on ACS verification, again this was more common at levels 2 and 3 and lower acuity. Another strategic position was trauma centers located in proximity of bordering states may also seek designation from those states. In other instances trauma centers carry a higher state designation than their ACS verification. The policy considerations and impact often related to abuse of trauma activation charges and state health agencies considering trauma center caps or modifying their certificate of need models.
Conclusion:
With tools such as the ACS NBATS and the advocacy of the COT there still exists a gap between the designation and verification processes. This gap leads to a high variance level between the types of trauma centers in a region yet allows them to function on an equal market platform. While there are studies examining outcomes between state designated vs. ACS verified trauma centers, there is a lack of more in-depth qualitative research exploring the policy implication of this regulatory gap and the long-term impact this may have on trauma volumes many years down the line.