A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

OBJECTIVE

To identify recommendations for conducting public health research with trauma-exposed populations.

METHODS

Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps.

RESULTS

We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research.

CONCLUSIONS

Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

Grady Health System's Mobile Integrated Health Program: A Statistical Analysis of Low-Acuity 911 Calls

Grady's Mobile Integrated Health (MIH) program works to manage outpatient health concerns that otherwise burden EDs, improve quality of care, and connect patients to the appropriate level of care and resources. This prospective study collected data from 09/01/2019-03/31/2020 to analyze Grady's MIH response to low-acuity 911 calls compared to a traditional EMS (ACLS/BLS) response. A total of 2,759 EMS calls were reviewed. These calls comprised the four most common emergency medical dispatch codes for Grady's MIH response: i) "sick person other pain," ii) "diabetic alert behaving normally," iii) "back pain," and iv) "falls." Descriptive statistics and multivariable logistic regressions (MLR) were performed to compare disposition differences between MIH and traditional EMS services in whether calls were mitigated on-scene or transported. For MIH responses (n=300), 66.1% were mitigated on-scene. Comparatively, for traditional EMS responses (n=263), 11.4% were mitigated on-scene. The MLR model found the odds that a patient was mitigated on-scene for an MIH response were 24 times that for an ACLS/BLS response (OR=24.19, p<0.001) after adjusting for patient sex, ethnicity, age, blood pressure, heart rate, pain response, glucose, time of day, and EMD code. The magnitude of the odds ratio significantly differed based on the dispatch code. The results of this study indicate that utilizing Grady's current MIH model is an effective way to mitigate low-acuity 911 concerns and decrease unnecessary ED utilization, while potentially reducing hospital readmissions and healthcare costs.