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May 9, 2017

How Ark. used a statewide trauma system to cut preventable deaths by half

Daily Briefing

In 2010, Arkansas retooled its "scattershot" regional trauma system into a well-regulated, statewide system—and research suggests the change helped curb preventable deaths and lower costs, John Commins reports for HealthLeaders Media.

Three steps to identify your own super-utilizers (and make your community healthier)

How Arkansas' system works

According to Commins, most trauma systems are organized at the regional rather than state level. But in 2010, Arkansas used $20 million in annual funding from a cigarette tax to revamp its system, which at the time had no state-designated trauma centers.

Under the retooled system, hospitals that wish to participate as trauma centers must undergo a state health department evaluation to make sure they meet state standards. As part of the system, the state also houses every ambulance under a single coordinated emergency medical services network.

Charles Mabry—an associate professor of surgery at the University of Arkansas for Medical Sciences, who was involved in the research—explained that when one of the ambulances picks up a patient, the emergency responders call central dispatch and describe the patient's condition. Dispatch then advises the ambulance "where to go based on their knowledge of the patient and also where the resources are," he said.

As part of the system, participating hospitals update a statewide web-based dashboard every hour to share information "about their capabilities and capacities," Mabry said. He explained, "That way, if something happens and a patient would ordinarily come to [a hospital that's backed up], the central dispatch would know to send [the patient] to another hospital."

The system also enables the state to track down any potential problems in care, Mabry said. Emergency responders give patients a tracking wristband when they are picked up that will follow the patient through the trauma system—so "if there are problems along the way, we can identify them," he explained.

Key findings

For the new study, published in the Journal of the American College of Surgeons, researchers assessed the economic impact of the new system in what Mabry said was the first return-on-investment analysis of a statewide trauma system.

The researchers compared data from 2009 (the year before the system was launched) with a 12-month period over 2013 and 2014. They found that after the new system was implemented, the preventable death rate fell from 30 percent to 16 percent—a 48 percent decrease that, according to the researchers, equates to 79 lives over one year.

The researchers also estimated the monetary value of lives saved to be $186 million—a nine-fold return on investment for taxpayers. To calculate the savings, the researchers used a standard estimate of $100,000 per life-year and an average lifetime expectancy of 81.5 years to get a lifetime value of $2.36 million per life saved. According to Mabry, given that most trauma patients are relatively young, the savings estimate is "conservative."

For other states looking to launch a statewide system, having a dedicated funding source is key, Mabry said. He noted that the $20 million in funding "is a lot of money around here" and "has driven a lot of the innovations in the trauma system" (Commins, HealthLeaders Media, 3/22).

Three steps to identify your own super-utilizers (and make your community healthier)

Explore three steps you can take to establish each patient’s current and future risk level, the root causes of the patient’s health risks, and which interventions would make the biggest impact.

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