Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Canada.
Ann Surg. 2012 Jul;256(1):163-9. doi: 10.1097/SLA.0b013e318256c20b.
To compare quality improvement (QI) programs of trauma centers in 4 high-income countries.
Injury is a leading cause of morbidity and mortality in countries around the world, but patient outcomes vary among countries with similar systems of trauma care.
We surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), and Australasia (Australia, n = 18; New Zealand, n = 3) regarding their QI programs. Quality indicators were requested from all centers that measured quality of care. Follow-up interviews were performed with 75 centers purposively sampled across 6 baseline criteria.
A total of 251 centers (76% response rate) responded to the survey, with a similar distribution across countries. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators (100% vs 94% vs 93%, P = 0.008), using report cards (53% vs 33% vs 31%, P = 0.033) and benchmarking (81% vs 61% vs 69%, P = 0.019). Centers in all 3 regions primarily used hospital process and outcome measures designed to establish whether care was safe (98% vs 97% vs 75%, P = 0.008), effective (97% vs 97% vs 92% P = 0.399), timely (88% vs 100% vs 92%, P = 0.055), and efficient (95% vs 100% vs 83%, P = 0.082). QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program.
This study provides the first international comparison of trauma center QI programs and demonstrates broad implementation in verified trauma centers in the United States, Canada, and Australasia. Significant variation exists in how trauma centers perform QI activities. Opportunities exist for improving and standardizing QI processes.
比较 4 个高收入国家创伤中心的质量改进（QI）项目。
在世界范围内，伤害是发病率和死亡率的主要原因，但具有类似创伤护理体系的国家之间，患者结局存在差异。
我们调查了美国（n=263）、加拿大（n=46）和澳大拉西亚（澳大利亚，n=18；新西兰，n=3）的 330 家经专业创伤组织验证的创伤中心的医疗主任和项目管理人员，了解他们的 QI 项目。向所有测量护理质量的中心请求质量指标。根据 6 项基线标准，对 75 家中心进行了有针对性的随访访谈。
共有 251 家中心（76%的回复率）对调查做出了回应，各国之间的分布情况相似。与加拿大和澳大拉西亚的创伤中心相比，美国的创伤中心更有可能报告测量质量指标（100%比 94%比 93%，P=0.008）、使用报告卡（53%比 33%比 31%，P=0.033）和基准测试（81%比 61%比 69%，P=0.019）。所有 3 个地区的中心主要使用旨在确定护理是否安全（98%比 97%比 75%，P=0.008）、有效（97%比 97%比 92%，P=0.399）、及时（88%比 100%比 92%，P=0.055）和高效（95%比 100%比 83%，P=0.082）的医院流程和结果测量方法。QI 项目在很大程度上具有本地性质，使用不同的标准来确定 QI 管辖范围内的患者，并采用不同的质量指标和改进策略。很少有中心评估其 QI 计划的有效性。
本研究首次对创伤中心的 QI 项目进行了国际比较，并展示了美国、加拿大和澳大拉西亚经过验证的创伤中心广泛实施 QI 项目。在创伤中心执行 QI 活动方面存在显著差异。有机会改善和标准化 QI 流程。
