Understanding disparities in Massachusetts trauma outcomes

Wenjun Li, Massachusetts Department of Public Health, health care reform, disparities and outcomes in trauma care

By Sandra Gray

UMass Medical School Communications

August 05, 2011
LifeFlight

UMass Medical School is teaming up with the Massachusetts Department of Public Health to help improve trauma care and outcomes. 

Photo credit: Paul MacCallum 

On an average day in the Commonwealth of Massachusetts, eight people die from traumatic injuries, adding up to more than 2,800 lives lost annually and more than 50,000 hospitalizations at a cost of $2.5 billion. While demographic and geographic disparities in access to trauma care have been documented, independent of whether or not individuals have health insurance, little is known about the impact of health care reform on eliminating these disparities and improving the survival rate of trauma victims.  

“We don’t know why such great health disparities exist in a state with such an advanced medical infrastructure and almost universal health insurance coverage, but we do have some hypotheses, such as residents of rural areas having fewer hospitals and thus poorer access to emergency care immediately after they are injured,” said Wenjun Li, PhD, associate professor of medicine and a member of the Division of Preventive and Behavioral Medicine. “Fortunately, Massachusetts has extensive data with which to test these hypotheses.” 

As the first state in the nation to enact landmark health care reform law, Massachusetts significantly increased the number of state residents insured by the end of 2010. This makes it the perfect real-life microcosm for identifying, analyzing and mitigating factors contributing to persistent health disparities. 

lisa-klein-and-laura-myers

Biostatistician Wenjun Li, PhD, pictured here giving a recent Department of Medicine Research Lecture, applies quantitative analysis to scientific questions

With a new, three-year, $1.2 million grant from the National Institute on Minority Health and Health Disparities, Dr. Li and co-investigator Sylvia Hobbs, MPH, director of research & evaluation for the Bureau of Health Care Safety and Quality at the Massachusetts Department of Public Health’s (DPH) Office of Emergency Medical Services, will conduct the first investigation using the new Erwin Hirsch State Trauma Registry and other hospital and vital records repositories to help understand—and make recommendations to resolve—the disparities in trauma outcomes for Massachusetts patients. Their investigation team includes program officials at DPH, and trauma surgeons from UMMS, Brigham and Women’s Hospital, Massachusetts General Hospital and the University of Vermont Medical School. 

Titled “Health care reform and disparities in the care and outcomes of trauma patients,” the study will analyze the impact of Massachusetts health care reform on the delivery and quality of trauma care, and identify changes in care delivery infrastructure and policies that are critical for quality improvement, cost reduction and ultimate elimination of disparities. The team will analyze data related to utilization, mortality, quality indicators, discharge dispositions and cost of trauma care. These population-based data sources comprise retrospective information on traumatic injuries both prior to and after the health care law’s enactment, allowing investigators to analyze geographic, socioeconomic and clinical factors associated with all episodes of care. 

The collaboration exemplifies the role government and academic research partnerships can play in mitigating health disparities, with Li’s unique expertise in spatial and socioeconomic analysis key to the study’s success. Li, who has already worked closely with the DPH on several projects, is gratified that the agency invited him to participate in improving trauma outcomes. “We hope the findings will fill a critical knowledge gap in the role of health care reform in elimination of health care disparities, adding timely, unique and valuable information to the current national health care policy debate,” he concluded.  

About biostatistics in Preventive and Behavioral Medicine 

Biostatistics is the application of quantitative analysis to answer scientific questions. Long a supporting element of scientific investigation, biostatistics is emerging as a valuable discipline unto itself, thanks to the efforts of practitioners like Li. “Quantitative skills allow you to ‘look’ at things that can’t be seen, only sensed,” said Li, whose health geography lab focuses on analyzing the impact of neighborhood environment on health and health behaviors. “Being exposed to all sorts of problems makes us open minded so that what we learn in one discipline can be applied to others.” 

A biostatistician in the Division of Preventive and Behavioral Medicine, Li is interested in identifying racial and socioeconomic disparities in health care, and helping public health agencies to prioritize their prevention or research efforts. He has applied statistical analysis to health care challenges including falls in the elderly, obesity, diabetes, physical inactivity and cigarette smoking. 

“My role in the Division of Preventive and Behavioral Medicine allows me to use my skills to address real world problems,” said Li. “We are looking for information on which to base practical recommendations to improve health care in Massachusetts.” 

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