The AAST Research and Education Fund is funding three scholarships for 2020-2021. The scholarship recipients will receive their scholarship plaque at the 79th Annual Meeting of AAST & Clinical Congress of Acute Care Surgery in Waikoloa, HI and will present their research findings at the 80th Annual Meeting of AAST & Clinical Congress of Acute Care Surgery in Atlanta, GA.
"Evaluating Enrollment of Uninsured Trauma Patients in Medicaid at the Time of Hospitalization Due to Injury"
Lisa Marie Knowlton, MD, MPH
Assistant Professor of Surgery
Division of Trauma and Surgical Critical Care
Stanford Hospital and Clinics
Nearly 28 million Americans remain uninsured and this number is anticipated to rise further with the recent health and economic impact of COVID-19 and spikes in unemployment. Trauma patients are especially vulnerable; they are subject to unanticipated catastrophic health expenditures, have higher rates of mortality, and have far more limited access to essential post-injury resources (e.g., rehabilitation, mental health services) compared to insured trauma patients. Further, hospitals treating uninsured trauma patients bear the brunt of uncompensated care as they are reimbursed for less than 20% of these inpatient costs. Therefore, despite trauma being challenging to predict, a coordinated effort is needed to ensure access to sustainable insurance coverage for all injured patients. A potential solution, Hospital Presumptive Eligibility (HPE), was enacted as part of the Affordable Care Act of 2014 in all states, regardless of Medicaid expansion status. HPE enables participating hospitals to initiate Medicaid enrollment for hospitalized uninsured patients. It provides temporary Medicaid coverage (up to 60 days), forcing patients to separately apply and qualify for a full, long-term Medicaid plan to continue coverage. Currently, little is known about the enrollment of trauma patients in HPE, as trauma registries and administrative data do not capture HPE status. By creating customized state-level Medicaid claims datasets, this research aims to identify the patient and hospital factors predictive of HPE participation and sustainment of Medicaid coverage post-HPE, as well as to characterize the health system factors that promote success of HPE Medicaid programs. This will provide an evidence-based framework for the design of future strategies at the state and national level to increase coverage among uninsured individuals and ultimately improve trauma patient outcomes.
"Immunomodulatory Effects of Cellular Contamination in Plasma Products for Transfusion"
Larry Yann-Leei Lee, MD
Assistant Professor of Surgery
University of South Alabama
The increasing use of liquid, never frozen plasma as an early step in resuscitation of hemorrhagic shock exposes patients to potentially immunomodulatory signals similar to that seen in pre-leukoreduction red cell transfusion with Transfusion Related Immunomodulation (TRIM). Combined with the finding that leukocyte contamination commonly seen in plasma products mobilizes inflammatory Damage Associated Molecular Patterns (DAMPs), the effect of exposure to intact and fragmented cells has unknown downstream effects immune cell phenotypes, activation, and function. This project seeks to characterize the effect of variable dose exposures of cells isolated from allogenic donors in a human blood assay to clarify these potentially deleterious effects, and thus better inform potential risks of transfusion as well as blood product preparation and administration.
"Optimization of Re-triage of Severely Injured Patients"
Anne M. Stey, MD, MSc
Trauma & Acute Care Surgery and Surgical Critical Care
Northwestern Memorial Hospital
In this award I will determine stability of re-triage transfer patterns in California and define re-triage processes of care leveraging a learning collaborative approach here in Illinois.