Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems

Abstract

Background: The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of “research done differently,” with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI’s innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. Objectives: This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. Conclusions: Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.

Integrating pragmatic and implementation science randomized clinical trial approaches: a PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) analysis

“…Commentary spanning pragmatic and implementation science clinical trial approaches suggests that policy integration could accelerate the research-to-practice translation; the recent NIH combined pragmatic and implementation trial announcement emphasized the importance of clinical trial policy relevance [ 5 , 9 , 14 , 16 – 21 ]. The ACS/COT has the capacity to invoke health care system level policy implementation strategies, including regulatory requirements linked to national trauma center verification site visits [ 44 ].…”

“…A planned end-of-study ACS/COT summit that convened stakeholders for a review of policy-relevant clinical trial findings was a central element of both trials. The presentation of policy-relevant findings derived from the trials was planned to occur within a single grant cycle, effectively reducing the time delay between the production of clinical trial research results and widespread health care system practice changes [ 6 , 14 , 16 , 21 ].…”

“…Pragmatic and implementation trials may be designed to target both individual patient effectiveness and provider-level practice change outcomes [ 5 , 7 , 8 , 13 – 15 ]. Also, cross-cutting commentary has encouraged the integration of policy targets into pragmatic and implementation clinical trial designs as an approach to accelerating health care system practice changes derived from clinical trial results [ 5 , 14 , 16 – 21 ]. Methodologic integration across pragmatic and implementation trials has the potential to provide clarity to clinical trial planning and grant submission and review and to improve the quality of clinical trial protocol and main outcome manuscript publications [ 9 , 22 ].…”

“…The American College of Surgeons Committee on Trauma (ACS/COT) has the capacity to invoke health care system-level regulatory policies that are guided by randomized clinical trial results. [ 14 , 31 – 33 ]. Both the DO-SBIS and TSOS trials included as a core design element, a multistep planning process targeting national trauma care system policy impact, that included an end-of-study policy summit [ 27 – 30 ].…”

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

“…The American College of Surgeons Committee on Trauma publishes clinical best practice guidelines that inform operation of US trauma centers and link trauma center designation to quality indicators. 30 The American College of Surgeons’ Resources for Optimal Care of the Injured Patient (2022 Standards) 31 includes a section on discharge planning, which requires that all trauma centers have a process to determine the level of care and the rehabilitation services required after trauma center discharge. These standards recommend, but do not require, that level I and II trauma centers adopt patient-centered strategies for facilitating patient transition into the community.…”