# Regional Trauma Systems of Care to Address Rural Disparities in Injury Mortality

> **NIH NIH R21** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $237,140

## Abstract

Abstract
Traumatic injury, defined as sudden and severe physical injury, is a leading cause of death and years of life
lost in the United States. Regional trauma systems, in which emergency medical providers and acute care
facilities integrate and coordinate triage and treatment of injured patients, are broadly implemented in the U.S.
and proven to reduce mortality through consolidated, specialized care at trauma centers. Limited access to
trauma centers is an important contributor to greater trauma mortality among people living in rural
communities. Despite efforts of regional trauma systems to ensure timely, high-quality care for all patients,
disparities in trauma mortality by rurality, race, ethnicity, and socioeconomic remain widespread. There is an
immediate need to understand the causes of trauma-related disparities across diverse rural and other
underserved populations. We propose systems science is needed to understand the causal mechanisms of
trauma-related disparities and identify high-impact interventions for rural and other underserved populations.
Our long-term research goal is to use complex systems theory and simulation modeling to design, implement,
and evaluate system-level changes to regionalized trauma care that improve population health and address
health disparities. System dynamics is an established modeling approach for complex, dynamic systems with
multiple cause-effect relationships and feedback loops. In this National Institute on Minority Health and Health
Disparities (NIMHD) R21 proposal, our short-term objective is to develop a causal loop diagram of regional
trauma systems informed by secondary analysis of existing data and key stakeholder input. We will create a
comprehensive dataset linking existing statewide data from North Carolina on EMS and in-hospital trauma
care, trauma patient mortality, and patient and community demographics and socioeconomic status. To
complement these quantitative data, we will engage regional trauma system stakeholders and subject matter
experts with qualitative system dynamics methods. Our specific aims are to: (1) evaluate rural, racial-ethnic,
and socioeconomic disparities in trauma triage and long-term mortality among North Carolina trauma patients;
and (2) create a causal loop diagram for a regional trauma system in North Carolina through stakeholder
engagement to identify potential high-impact interventions to address trauma disparities. Upon successful
completion of these aims, we will have produced essential preliminary data on trauma-related disparities in
rural and other subgroups to pursue system dynamics research to understand and improve population health
and quality of care for underserved populations. The proposed research and our long-term research goal has
potential for significant scientific impact on health systems modeling that can directly contribute to improving
outcomes for patients experiencing acute, life-threatening illness and injury.

## Key facts

- **NIH application ID:** 10935966
- **Project number:** 5R21MD019082-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Michelle Meyer
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $237,140
- **Award type:** 5
- **Project period:** 2023-09-25 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10935966

## Citation

> US National Institutes of Health, RePORTER application 10935966, Regional Trauma Systems of Care to Address Rural Disparities in Injury Mortality (5R21MD019082-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10935966. Licensed CC0.

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