els, and recommends the reauthorization of trauma care systems planning, development, and outcomes research at the Health Resources and Services Administration (HRSA).

To ensure the success of this recommendation, resources should be provided to stimulate the development and evaluation of trauma systems in states and regions with the greatest need for systems development.

Trauma care is lifesaving, yet expensive. The costs of trauma systems development should be shared by federal, state, and local governments. About half of the states report having some kind of trauma system, although their nature and extent are not well documented. Some of the most successful statewide trauma systems have flourished with dedicated sources of funding through motor vehicle fees and other creative approaches. Research has begun to demonstrate that the investment in systems of care can be cost-effective in terms of long-term health care costs and productivity.

The committee recommends intensified trauma outcomes research, including research on the delivery and financing of acute care services and rehabilitation. The committee envisions that HRSA and other appropriate federal agencies (e.g., NCIPC, and the Agency for Health Care Policy and Research [AHCPR]) will collaborate on this research.

Specific areas of research that have to be addressed include the following:

  • the cost-effectiveness of specific clinical and service interventions to establish best practices in trauma care;

  • the most efficient and effective strategies for organizing and financing the delivery of both acute care services and rehabilitation, including the impact of managed care arrangements on access to services, quality of care, and outcomes; and

  • the development of improved methods for measuring the severity of injury, particularly for those at high risk of adverse outcomes.

STATE AND COMMUNITY RESPONSE

Further progress in reducing the burden of injuries not only depends on concerted research and treatment efforts but also requires a strengthened focus on prevention implementation. Great strides have been made in developing injury prevention strategies that have been shown to be successful in promoting safety and reducing injury morbidity and mortality. In most cases, injury prevention is best achieved through a multifaceted approach that utilizes the range of available prevention strategies. However, the state and community response is often ham-



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