Department of Surgery, University of Washington, Seattle, USA.
Harborview Injury Prevention and Research Center, Seattle, USA.
World J Surg. 2022 May;46(5):1059-1066. doi: 10.1007/s00268-022-06461-9. Epub 2022 Feb 6.
We aimed to identify and describe demand-side factors that have been used to support ATLS global promulgation, as well as current gaps in demand-side incentives.
We performed a cross-sectional survey about demand-side factors that influence the uptake and promulgation of ATLS and other trauma-related CME courses. The survey was sent to each of the four global ATLS region chiefs and 80 ATLS country directors. Responses were described and qualitative data were analyzed using a content analysis framework.
Representatives from 30 countries and each region chief responded to the survey (40% response rate). Twenty of 30 country directors (66%) reported that there were some form of ATLS verification requirements. ATLS completion, not current verification, was often the benchmark. Individual healthcare systems were the most common agency to require ATLS verification (37% of countries) followed by medical/surgical accreditation boards (33%), governments (23%), training programs (27%), and professional societies (17%). Multiple credentialing frameworks were reported including making ATLS verification a requirement for: emergency unit or trauma center designation (40%), contract renewal or promotion (37%); professional licensing (37%); training program graduation (37%); and increases in remuneration (3%). Unique demand-side incentives were reported including expansion of ATLS to non-physician cadre credentialing and use of subsidies.
ATLS region chiefs and country directors reported a variety of demand-side incentives that may facilitate the promulgation of ATLS. Actionable steps include: (i) shift incentivization from ATLS course completion to maintenance of verification; (ii) develop an incentive toolkit of best practices to support implementation; and (iii) engage leadership stakeholders to use demand-side incentives to improve the training and capabilities of the providers they oversee to care for the injured.
本研究旨在确定和描述支持 ATLS 全球推广的需求方因素，以及当前需求方激励措施的差距。
我们对影响 ATLS 和其他创伤相关 CME 课程采用和推广的需求方因素进行了横断面调查。该调查发给了四位全球 ATLS 区域负责人和 80 位 ATLS 国家主任。通过内容分析框架对调查结果进行描述和定性数据分析。
来自 30 个国家的代表和每位区域负责人都对该调查做出了回应（回应率为 40%）。30 个国家主任中有 20 位（66%）报告存在某种形式的 ATLS 验证要求。ATLS 完成情况而非当前验证情况通常是基准。要求 ATLS 验证的最常见机构是各个医疗保健系统（37%的国家），其次是医疗/外科认证委员会（33%）、政府（23%）、培训项目（27%）和专业协会（17%）。报告了多种认证框架，包括将 ATLS 验证作为以下要求：急诊单位或创伤中心指定（40%）、合同续签或晋升（37%）、专业许可证（37%）、培训项目毕业（37%）以及薪酬增加（37%）。还报告了独特的需求方激励措施，包括将 ATLS 扩展到非医师干部认证和使用补贴。
ATLS 区域负责人和国家主任报告了多种需求方激励措施，这些措施可能有助于 ATLS 的推广。可采取的措施包括：（i）将激励措施从 ATLS 课程完成转移到维持验证；（ii）制定最佳实践激励工具包以支持实施；（iii）让领导层利益相关者参与进来，利用需求方激励措施来提高他们监督的提供者的培训和能力，以救治伤者。
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