Obtaining Federal Funding in Burns: What Worked and What Didn’t. Tina L. Palmieri MD, FACS, FCCM President, American Burn Association Professor, University of California Davis Assistant Chief of Burns, Shriners Hospitals for Children Northern California. Objectives.
Tina L. Palmieri MD, FACS, FCCM
President, American Burn Association
Professor, University of California Davis Assistant Chief of Burns, Shriners Hospitals for Children Northern California
Consumer: Rejection of Paternalism and Distrust of Managed Care
OBJECTIVITY IN MEDICINE
Explosion of Information and technology
The Crisis of Cost
1. Not a SINGLE :”Standard” supported by Class I evidence
2. 5 “Guidelines” supported by Class II evidence
3. 11 “Options” supported by Class III evidence or a preponderance of opinion.
* Medline review 1990-1997
* 56 RCT’s for burns, most dealing with wound care techniques or products.
“There is little evidence that burn care is an evidence-based practice.”
--Childs, Burns, 1998;24:29-33.
Real Multicenter Groups have
*Patient Safety Boards
*External Review Boards
*Centralized Data Storage
*Palmieri TL, et al. JBCR.2007;28:544-5.
**Greenhalgh DG, et al. JBCR. 2007;28:776-90.
***Palmieri TL, et al. JBCR. 2009;30:141-210.
The Burn Outcomes Research Infrastructure (BORI) Project
Practice Guidelines in Burn Care Outcomes
Project Began, 1998. Meetings held throughout 1998,1999.
Experts in burn care and guideline development.
Funding from Paradigm Health Care, National Coalition of Burn Center Hospitals, American Burn Association.
To develop Practice Guidelines for the acute, early treatment of burn patients.
13 Chapters dealing with organization of burn care, initial assessment, fluid resuscitation, airway and inhalation injury management, Nutrition, DVT Prophylaxis.
Input sought from Society of Critical Care Medicine, American Association for the Surgery of Trauma, American College of Surgeons, American College of Emergency Physicians.
Presented 2000 meeting ABA
The OutcomesTRACS™/ABA Burn Registry
A. Began in 1988 B. Over 300,000 patient records C. Requirement for ABA/ACS Burn Center Verification
American Burn Association National Burn Repository 2012.