PROJECT SUMMARY/ABSTRACT In the United States, trauma is the leading cause of death for individuals under the age of 45 and was responsible for $671 billion in economic damage in 2013. Despite growing standardization of clinical trauma care, at Level I and Level II trauma centers, there remains significant variability in patient outcomes across trauma centers on both levels. To resolve this issue, two knowledge gaps will be addressed: a) which organizational features impact patient outcomes and b) which organizational features are indicative of institutional commitment. Our global hypothesis is that variability of organizational features in Level I and Level II trauma centers is a significant factor in the variability of patient outcomes across those trauma centers. We will also collect data on which organizational features are indicative of institutional commitment from the perspective of trauma experts. In Aim 1 we will collect data about the organizational characteristics and patient outcomes at 230 Level I and Level 2 trauma centers. These centers will also provide us with their Trauma Quality Improvement Program data, which includes patient outcomes. To support our global hypothesis, we will use these data to test whether organizational features of the trauma centers show an impact on patient outcomes, specifically patient mortality, length of stay, and risk-adjusted major complications. In Aim 2 we will use the data about organizational characteristics to assess which organizational features of trauma centers are indicative of institutional commitment using Latent Class analysis. This will allow us to represent the dependencies between organizational features and institutional commitment and add this information to the TIPTOE database. We will use these data to create automatic inferences on patterns of institutional commitment to represent, group and analyze factors indicative of institutional commitment using data collected in the present project. This provides an additional source of knowledge guiding trauma center planning and decision-making. In Aim 3 we will extend the Ontology of Organizational Structures of Trauma Centers and Trauma Systems (OOSTT) to include institutional commitment and patient outcomes. We will set up the TIPTOE Knowledge Base and create the Knowledge Path tool for users to explore, analyze, and visualize TIPTOE data. We will test the hypothesis that the TIPTOE Knowledge Path is perceived to make a positive impact on knowledge discovery and decision making in the user community. This project will initialize a novel resource of patient outcome information for the trauma care community. The purpose of this project is the next evolution of trauma center quality improvement allowing change based on scientific evidence of which components of trauma centers affect patient outcomes.