Organizational Readiness of The Georgia Trauma System to Implement the Cardiff Model
Project Lead:
Daniel Wu, MD | Grady Memorial Hospital
Project Co-Lead:
Jessica Sales, PhD | Emory University, Rollins School of Public Health
Jasmine Moore, MPH | Grady Memorial Hospital
Partner Organizations:
Grady Memorial Hospital, Georgia Trauma Commission, Children’s Hospital of Atlanta, Doctor’s Hospital of Augusta, Atrium Health Navicent, Phoebe Putney Memorial Hospital, and Albany Police Department
Research Gap:
In the US, 49% of violent crimes are not reported to the police, and this under reporting undermines prevention efforts. People that are injured to the point of needing medical attention are likely to present at the local trauma center or hospital. Adoption of the Cardiff model in the US has identified data sharing challenges between police, government public health systems and healthcare systems.
Description:
Although the Cardiff Model has been successfully implemented in the UK, there exist fundamental differences in healthcare delivery and law enforcement in the U.S. that create barriers to a direct translation of the model to the U.S. Until now, Cardiff Model implementations in the U.S. have only occurred at single hospital and law enforcement sites, and only with limited success due to the unique and disparate healthcare and law enforcement systems in the U.S. Some challenges experienced by previous U.S. implementations include HIPPA privacy concerns, varied types of proprietary health records, and inconsistent buy-in from staff based on institutional mission. Uniquely in the U.S., there is a lack of a single national, regional or even local healthcare or law enforcement system which dictates that any effective data sharing partnerships will be the result of labor and time intensive partnership building across multiple agencies that may or may not share a common mission. The U.S. implementations have demonstrated that differences exist at the both the national and local level and a variety of organizations need to be assessed to gain a true understanding of the barriers that a widespread implementation would encounter. This study will perform an organizational readiness assessment of hospitals within a statewide trauma system and their law enforcement partners to implement the Cardiff model of data-sharing. It will establish the necessary methods for a model to implement hospital/police partnerships across the U.S. If successful in identifying barriers and establishing the groundwork for partnerships, we will be ready to implement the Cardiff injury program leveraging the existing structure of the Georgia statewide trauma system.
Aims:
- Identify existing barriers for trauma hospital implementation of the Cardiff model
- Identify existing barriers for law enforcement implementation of the Cardiff Model
- Identify cross-sectoral practice amongst hospitals, law enforcement and community group that could support the creation of community level violence prevention partnerships.
Why is this project important?
Addressing data sharing challenges and establishing a national network will provide the opportunity for trauma centers and their communities to reduce violent injuries.
The Cardiff Model for Violence Prevention is a known efficacious approach to preventing violent injury. This model involves a data sharing partnership between trauma hospitals, law enforcement, and community groups. The partnership focuses on identifying violence hotspots that are unknown to law enforcement and helping communities implement known efficacious site-based intervention to address these hotspots. Results of this project will support improvement to the CDC Cardiff Model tool kit and identify barriers and facilitators to Cardiff Model implementations at trauma hospitals in the U.S.
- An advisory board consisting of leads of past/current Cardiff model implementations was formed, and structured interviews were conducted. Results of these interviews identified key facilitators and barriers to implementation success including whether there were pre-existing relationships between partners and whether a commitment to violence prevention was part of the healthcare culture at hospitals implementing the Cardiff model.
- A key facilitator of success was describing the intervention and conveying what the intervention looks like at scale rather than what it looks like on an individual institution level.
- A key issue for implementation was the changing trust-relationship between healthcare and communities and police and communities associated with COVID-19, arising from skepticism of science and increased community violence/distrust of police.
- Through the Georgia Trauma Commission, we recruited four trauma centers and one law enforcement partner to participate in the organizational readiness assessment.
- The findings from the advisory board interviews were coded using the Consolidated Framework for Implementation Research (CFIR) and used to create an interview guide for hospital, law enforcement and community partners.
- Interviews have been conducted with the Children’s Healthcare of Atlanta hospitals (Egleston and Scottish Rite), Phoebe Putney Hospital, Albany Police Department, Atrium Health Navicent Hospital in Macon, Georgia, and the Grady Health System. Interviews were across multiple sectors including healthcare, law enforcement, public health, government, and community leaders. In total, over 35 interviews have been conducted.
