# Trauma Center Characteristics that Drive Quality, Cost and Efficiency in Lower Extremity Injuries

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $93,758

## Abstract

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
meth...

## Key facts

- **NIH application ID:** 10438921
- **Project number:** 5K23AR079565-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Bryant Oliphant
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $93,758
- **Award type:** 5
- **Project period:** 2021-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10438921

## Citation

> US National Institutes of Health, RePORTER application 10438921, Trauma Center Characteristics that Drive Quality, Cost and Efficiency in Lower Extremity Injuries (5K23AR079565-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10438921. Licensed CC0.

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