From the US Army Institute of Surgical Research, Fort Sam Houston, Texas.
J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S459-64. doi: 10.1097/TA.0b013e3182754887.
The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with the acceptance of evidence-based practices and decreases in trauma practice variability.
The current evaluation was designed as a single time-series quasi-experimental study as a preanalysis and postanalysis relative to the implementation of clinical practice guidelines and process improvement interventions. Data captured from patients admitted to hospital-level (Level III) military treatment facilities in Iraq and Afghanistan from 2003 to 2010 were retrospectively analyzed from the Joint Theater Trauma Registry (JTTR) to determine the potential impact of process improvement initiatives on clinical practice.
The JTTS clinical practice guidelines for massive transfusion led to increased compliance with balanced component transfusion and decreased practice variability. During the course of the evaluation period, hypothermia on presentation decreased dramatically after the publication of the hypothermia prevention and management clinical practice guideline.
Developed metrics demonstrate that evidence-based quality improvement initiatives disseminated through the JTTS were associated with improved clinical practice of resuscitation following battlefield injury.
Therapeutic/care management study, level IV.
联合战区创伤系统（JTTS）的开发愿景是，战场上的每一名士兵、海军陆战队员、水手和飞行员受伤后，都有最佳的生存机会和最大的功能恢复潜力。在这项分析中，我们假设通过 JTTS 传播信息，即通过传播临床实践指南和改进流程，将与接受循证实践以及减少创伤实践变异性相关联。
本次评估设计为单次时间序列准实验研究，相对于临床实践指南和流程改进干预措施的实施进行了预分析和后分析。从 2003 年至 2010 年，从联合战区创伤登记处（JTTR）中回顾性分析了从伊拉克和阿富汗的医院级（三级）军事治疗设施收治的患者的数据，以确定流程改进举措对临床实践的潜在影响。
JTTS 大量输血的临床实践指南导致平衡成分输血的依从性增加，实践变异性降低。在评估期间，在发布低温预防和管理临床实践指南后，体温过低的发生率在入院时显著降低。
开发的指标表明，通过 JTTS 传播的循证质量改进举措与战场受伤后复苏的临床实践改善相关。
治疗/护理管理研究，四级。
