Mould-Millman Nee-Kofi, Dixon Julia, Lee Michael, Meese Halea, Mata Lina V, Burkholder Taylor, Moreira Fabio, Bester Beatrix, Thomas Jacob, de Vries Shaheem, Wallis Lee A, Ginde Adit A
Department of Emergency Medicine University of Colorado Denver School of Medicine Aurora Colorado USA.
Western Cape Government, Department of Health Emergency Medical Services Cape Town South Africa.
Health Sci Rep. 2021 Oct 14;4(4):e422. doi: 10.1002/hsr2.422. eCollection 2021 Dec.
Improving the quality of pre-hospital traumatic shock care, especially in low- and middle-income countries, is particularly relevant to reducing the large global burden of disease from injury. What clinical interventions represent high-quality care is an actively evolving field and often dependent on the specific injury pattern. A key component of improving the quality of care is having a consistent way to assess and measure the quality of shock care in the pre-hospital setting. The objective of this study was to develop and validate a chart abstraction instrument to measure the quality of trauma care in a resource-limited, pre-hospital emergency care setting.
Traumatic shock was selected as the tracer condition. The pre-hospital quality of traumatic shock care (QTSC) instrument was developed and validated in three phases. A content development phase utilized a rapid literature review and expert consensus to yield the contents of the draft instrument. In the instrument validation phase, the QTSC instrument was created and underwent end user and content validation. A pilot-testing phase collected user feedback and performance characteristics to iteratively refine draft versions into a final instrument. Accuracy and inter- and intra-rater agreement were calculated.
The final QTSC instrument contains 10 domains of quality, each with specific criteria that determine how the domain is measured and the level of quality of care rendered. The instrument is over 90% accurate and has good inter- and intra-rater reliability when used by trained pre-hospital provider users in South Africa. Pre-hospital provider user feedback indicates the tool is easy to learn and quick to use.
We created and validated a novel chart abstraction instrument that can reliably and accurately measure the quality of pre-hospital traumatic shock care. We provide a systematic methodology for developing and validating a quality of care tool for resource-limited care settings.
提高院前创伤性休克的救治质量，尤其是在低收入和中等收入国家，对于减轻全球因伤所致的巨大疾病负担尤为重要。何种临床干预措施代表高质量的救治是一个不断发展的领域，且通常取决于具体的损伤模式。提高救治质量的一个关键要素是要有一种一致的方法来评估和衡量院前环境下休克救治的质量。本研究的目的是开发并验证一种图表提取工具，以测量资源有限的院前急救环境下创伤救治的质量。
选择创伤性休克作为追踪病种。院前创伤性休克救治质量（QTSC）工具分三个阶段进行开发和验证。内容开发阶段利用快速文献综述和专家共识得出工具草案的内容。在工具验证阶段，创建了QTSC工具并进行了最终用户和内容验证。试点测试阶段收集用户反馈和性能特征，以将草案版本迭代完善为最终工具。计算了准确性以及评分者间和评分者内的一致性。
最终的QTSC工具包含10个质量领域，每个领域都有特定的标准，这些标准决定了该领域的测量方式以及所提供的救治质量水平。该工具的准确率超过90%，在南非由经过培训的院前急救人员使用时，具有良好的评分者间和评分者内可靠性。院前急救人员的用户反馈表明该工具易于学习且使用快捷。
我们创建并验证了一种新型图表提取工具，它能够可靠且准确地测量院前创伤性休克救治的质量。我们提供了一种系统方法，用于开发和验证资源有限的救治环境下的救治质量工具。
