Publications by authors named "Molly P Jarman"
Article Synopsis
- Quality benchmarking in geriatric trauma care has shifted from short-term outcomes like morbidity and mortality to long-term metrics, with healthy days at home (HDAH) emerging as a useful measure of patient functional status.
- A study of 772,109 Medicare patients showed that factors such as age, race, and level of care significantly impacted the number of HDAH following trauma.
- The findings indicate that higher level trauma centers lead to better outcomes in terms of HDAH, suggesting a need for future research on quality of life metrics post-discharge.
Introduction: Many seriously injured older adults are not transported to trauma centers (TCs), a phenomenon known as undertriage. System-level factors that contribute to undertriage are poorly understood. One important system-level factor is the regional supply of TCs.
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Article Synopsis
- Mild cognitive impairment in older adults increases the risk of falls and may relate to a higher likelihood of developing Alzheimer's disease and related dementias (ADRD) after a fall.
- A study using Medicare data from 2014-2015 examined older adults (66+) who suffered traumatic injuries and looked at their risk of a new ADRD diagnosis following a fall.
- The findings revealed that individuals who fell had a significantly higher incidence of ADRD diagnosis within a year (10.6%) compared to those with other injury causes (6.1%), indicating that falls may be an important risk factor for dementia development.
Article Synopsis
- * Community emergency medical services (CEMS) can help identify older adults at risk for falls and offer timely prevention services at home.
- * Analysis of emergency department data shows that a notable percentage of older adults who experienced falls previously engaged with EMS, highlighting a correlation between prior EMS use, poorer health, and lower socioeconomic status.
Article Synopsis
- * Community Emergency Medical Services (CEMS) can quickly identify older adults at risk of falls and offer preventative care at home, which shows promise based on research reviewed.
- * The review included 35 studies indicating that CEMS interventions not only reduced emergency department visits and repeat falls but also improved the overall quality of life for older adults, suggesting a need for broader implementation of these programs.
What you don't know can hurt you: a statistical commentary on missing data in trauma research.
Trauma Surg Acute Care Open
April 2024
Geographic information systems and spatial analysis: a statistical commentary.
Trauma Surg Acute Care Open
March 2024
Article Synopsis
- - Trauma is a major global issue, causing millions of deaths each year, but its effects also include long-term physical and mental health problems for survivors.
- - The economic impact of trauma is significant, with high healthcare costs and decreased productivity adding strain to national economies.
- - There are notable disparities in trauma care access that affect different groups, highlighting the need for improvements in the entire trauma care process to ensure equitable treatment and better outcomes for all patients.
Background: Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia.
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- Trauma registries currently collect data only during the hospital stay, missing long-term patient information after discharge, which hampers improvement programs.
- This study aimed to create a comprehensive patient record by linking trauma registry data with insurance claims data to track patients beyond discharge.
- The successful linkage resulted in a 27.5% overall match rate, highlighting the potential for better understanding long-term outcomes and enhancing patient care.
Article Synopsis
- Firearm injuries have reached epidemic levels in the US, with over 45,000 fatalities recorded in 2020, highlighting the need for understanding socioeconomic factors influencing these rates.
- This study investigates the relationship between neighborhood gentrification and the incidence of firearm injuries over time, utilizing urban US Census tract data from 2010 to 2019.
- Results indicate that gentrifying neighborhoods experience a 62% higher rate of firearm injuries compared to non-gentrifying areas with similar demographics, suggesting a significant link between gentrification and firearm injury risks.
Article Synopsis
- Geographic information systems (GIS) were used to analyze trauma response times in Maryland, specifically looking at the impact of including Walter Reed National Military Medical Center (WRNMMC) in the local trauma system alongside existing hospitals.* -
- The study created catchment areas to assess patient access at different time periods, finding that all areas improved access, particularly the shortest time frames (0-15 minutes), while some socioeconomic and diversity groups also saw increased coverage.* -
- The findings suggest that adding WRNMMC could enhance timely trauma care for the population, potentially providing consistent coverage in various traffic scenarios or when civilian hospitals are overwhelmed.*
Objective: To characterize hospital-level professional networks of physicians caring for older trauma patients as a function of trauma patient age distribution.
Background: The causal factors associated with between-hospital variation in geriatric trauma outcomes are poorly understood. Variation in physician practice patterns reflected by differences in professional networks might contribute to hospital-level differences in outcomes for older trauma patients.
Article Synopsis
- In 2015, the U.S. transitioned from ICD-9 to ICD-10 coding for emergency general surgery (EGS) diagnoses, prompting a need to establish an equivalent list of ICD-10 codes using a general equivalence mapping (GEM).
- The study compared the patient volumes admitted with EGS diagnoses during the ICD-9 and ICD-10 periods, identifying discrepancies and issues in the mapping process that resulted in 485 ICD-9 codes mapping to 1,206 ICD-10 codes, with only 40% having exact one-to-one matches.
- Key challenges in the GEM crosswalk included changes in admission volumes, loss of critical modifiers, absence of specific ICD-10 codes, inaccurate mapping, and
Background: Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM.
Methods: Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM.
Article Synopsis
- The study investigates whether 1930s redlining practices in the U.S. correlate with current community-level firearm injury rates, highlighting the lasting impact of discriminatory housing policies on public health.
- Using a nationwide cohort study, researchers compared urban areas affected by redlining to similar non-redlined areas, finding a significant increase in firearm incidents associated with those historically impacted neighborhoods.
- The findings suggest that efforts to address the legacy of redlining could potentially reduce modern-day firearm violence, indicating a link between historical policies and ongoing public health issues.
Article Synopsis
- A study analyzed Medicare inpatient claims from 2014-2015 to investigate care discontinuity in geriatric trauma patients, focusing on readmissions to non-index hospitals and their impact on mortality.
- Over 754,000 patients were included, with 2.87% experiencing readmission within 30 days, and among those, 34% went to non-index hospitals; mortality rate after readmission was found to be 25%.
- The key findings indicated that while readmission diagnoses and hospital factors contributed to care discontinuity, it surprisingly did not lead to higher mortality in these patients, suggesting the need for further research on care processes.
Context: As part of the launch of the Geriatric Surgery Verification program in 2019, the American College of Surgeons issued care standards for older patients, including requirements for preoperative documentation of patients' goals. Hospital performance on these standards prior to the Geriatric Surgery Verification program is unknown.
Objectives: To assess baseline performance of the Geriatric Surgery Verification (GSV) standard for documentation of preoperative goals for older patients, and to determine factors associated with standard adherence.
Article Synopsis
- This study investigates how rural living and socioeconomic status affect outcomes after orthopedic trauma surgery, focusing on fractures.
- Researchers analyzed data from over 235,000 patients to determine if rural patients faced higher risks of mortality and complications compared to urban patients.
- The findings revealed that rural status increased the risk of mortality for hip fracture patients but not for other fracture types, and low income was linked to higher mortality in urban polytrauma patients only.
Article Synopsis
- Current guidelines recommend performing cholecystectomy (gallbladder removal) during the initial hospital stay for patients with gallstone pancreatitis, ideally within 48 hours, but adherence to these recommendations is low.
- An analysis of 163,390 patient admissions showed that only 55.6% had a cholecystectomy before discharge, with early surgeries occurring in just 27% of cases, and larger hospitals and urban teaching centers were more likely to perform same-admission surgeries.
- To improve surgical care delivery for gallstone pancreatitis, targeted interventions should focus on smaller hospitals, rural regions, and health systems in the Northeast, where adherence to best practices is particularly lacking.
Accessibility of Level III trauma centers for underserved populations: A cross-sectional study.
J Trauma Acute Care Surg
November 2022
Background: By providing definitive care for many, and rapid assessment, resuscitation, stabilization, and transfer to Level I/II centers when needed, Level III trauma centers can augment capacity in high resource regions and extend the geographic reach to lower resource regions. We sought to (1) characterize populations served principally by Level III trauma centers, (2) estimate differences in time to care by trauma center level, and (3) update national estimates of trauma center access.
Methods: In a cross-sectional study (United States, 2019), we estimated travel time from census block groups to the nearest Level I/II trauma center and nearest Level III trauma center.