Register Today for Year 2 of the Future of Trauma Research and Clinical Guidance Conference Series – February 19-20, 2025

Lacey LaGrone, MD, MPH, FACS, is on a mission to democratize trauma clinical guidance in the United States and, eventually, across the world.

Trauma clinical guidance resides in a chaotic landscape of have’s and have-not’s, with dire consequences. “We know that where you are injured, in part, determines whether you survive,” said LaGrone. Large, urban Level 1 centers have the latest guidance at their fingertips and the resources to meet it. In contrast, centers at lower levels and rural hospitals struggle to stay current and often don’t have access to the right equipment or expertise in-house, regardless.

Her own disparate experiences convinced her of the imperative to solve this problem. As an NIH-funded Fogarty Fellow in Peru, LaGrone conducted trauma quality improvement research. In explaining why there was no Morbidity & Mortality review at his Lima hospital, one surgeon told her it was because it wasn’t helpful; people just gave subjective opinions.

“He told me that while a case was being discussed, he looked up a clinical issue on his phone and quickly gave a recommendation based on the abstract he had just read. Everyone in the room was impressed and subsequently perceived him to be an expert,” said LaGrone. More agile with online searches and more fluent in English than his peers, he had simply been able to Google the answer. “That story really illustrated for me how access to information—in many languages—is low-hanging fruit for improving care,” she said.

While LaGrone trained at the University of Washington—a Level 1 center with an efficient and authoritative internal information sharing system—she now works within a system where clinical guidance is fragmented, difficult to access, and sparse. She came to understand that the latter situation is more prevalent across medicine in the U.S., not just in other countries, and hinders the provision of optimal, evidence-based care. “Once I realized that across resource contexts, there is often little access to relevant and reliable point-of-care information, I wanted to participate in more far-reaching solutions for this problem,” she said.

Initially, LaGrone submitted a proposal to CNTR for an intervention study to test a new approach to guideline development and dissemination. But on review, CNTR’s Scientific Advisory Committee (CNTR-SAC) suggested that she first pursue an R13 grant to build multidisciplinary consensus around a solution. “CNTR-SAC advises early-career investigators on proposal ideas and guides them toward a successful application submission,” said CNTR’s Executive Director, Michelle Price, PhD. Partnering with CNTR on an ambitious conference series proposal, in 2023, LaGrone won a three-year grant from the Agency for Healthcare Research and Quality (AHRQ) to do just that.

The conference series—Design for Implementation (DFI): The Future of Trauma Research and Clinical Guidance—engages a group of leaders throughout three years of annual meetings and interim work to conceive the solution to this problem, design an ideal system, and finally to test the system they create.

Held in February 2024, the first meeting in the DFI series (bit.ly/DesignImplement) focused on generating consensus around the barriers to and facilitators for improved clinical guidance. Participants captured the perspectives and needs of various trauma community segments and identified several key priorities for an improved trauma guidance environment, including:

• A compassionate patient experience
• Guidance stratified by resource environment, patient characteristics, and community context
• Equitable access to guidance, ideally in a central repository
• Engagement of patients and communities in guidance development
• Leveraged with technology
• Sustainably funded

To conduct complementary implementation and dissemination research, LaGrone applied for and was awarded a $50,000 scholarship from the American Association for the Surgery of Trauma (AAST). That grant will support her work to identify the essential features for a trauma clinical guidance product through surveys and brokered dialog with injury community partners. In addition, LaGrone has initiated meetings with trauma professional society leaders to foster a collaborative environment for trauma clinical guidance creation and dissemination.

Year two of DFI—to be held February 19-20, 2025, once again hosted by the American College of Surgeons in Chicago—will focus on how to ensure that future clinical guidance efforts are synergistic, with an emphasis on pragmatic research and hybrid trials. Participants will assess the acceptability, feasibility, and appropriateness of clinical guidance and outline the next steps in developing optimal clinical guidance and guidance dissemination mechanisms. All trauma providers and clinical guidance leaders are invited to be agents of change, and to attend and participate virtually at no cost (Register here: bit.ly/DesignImplement).

LaGrone plans to package the results from the conference series and the work happening between meetings as the foundation for an Agency for Healthcare Research and Quality R18 Dissemination grant proposal. This final capstone grant will support the initiative’s key phase: Active Dissemination.

“The ultimate goal is to achieve an informed re-design of our national approach to trauma clinical guidance,” explained LaGrone. She envisions a portal on the CNTR website as the open-access clearinghouse for this guidance.

[Funding for this conference was made possible [in part] by grant number 1R13HS028940-01A1 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.]