During the study period, the system included 6 level I (including 2 pediatric), 4 level II, 21 level III, and 28 level IV trauma centers. Trauma level designations are based on American College of Surgeons criteria and are revised periodically with on-site visits. The Quebec trauma system was instated in 1993 and involves regionalized care from urban level I trauma centers through to rural community hospitals. This multicenter retrospective cohort study was based on the inclusive trauma system of the province of Quebec, Canada.
PPI that could be measured using the Quebec Trauma Registry were then identified (and calculated for each of the 59 designated trauma centers. PPI definitions that varied across systems for the same indicator (e.g., delays to operate) were refined by the steering committee. PPI definitions were based on the literature. PPI were selected if they met any of the following three criteria: Supported by the literature, used by at least two systems without literature support, or suggested by the group of experts.
Third, a multidisciplinary group of clinical experts serving as a steering committee for the Quebec provincial trauma system had already established 14 PPI they intended to follow.
#Miemss trauma center levels professional#
Second, a review of websites of state/provincial authorities, professional associations, and trauma centers from the USA, Canada, and Australia was performed to identify PPI that were used in practice. First, a review of the literature was performed to identify which of these PPI were supported by literature published between 19 using PubMed, EmBase, CINAHL, Cochrane, and Proquest.
#Miemss trauma center levels series#
The objectives of this study were to (1) identify a series of process performance indicators (PPI) supported by literature review and/or expert consensus that can be calculated using trauma registry data and (2) evaluate selected PPI in terms of discrimination, construct validity, and forecasting. In addition, while numerous process indicators have been suggested in the literature, many cannot be applied using registry data, and evidence of their validity is scarce. According to the US Agency for Healthcare Quality, performance indicators should be evaluated using measures of discrimination, validity, and forecasting.Ĭurrently, trauma quality assurance activities vary greatly across trauma systems and are often limited to hospital-based audit of adverse patient outcomes despite the availability of clinical data in trauma registries. Accessibility implies that they can be evaluated at low cost with data that are easy to obtain on a routine basis. Process indicators refer to clinical processes performed in the health care setting and should be relevant, reliable, accessible, and clear. The most widely used conceptual model for health care performance evaluation, proposed by Donabedian, describes performance according to three domains: Structure, process, and outcome. Evidence has suggested that the dissemination of data on performance can lead to improvements in the quality and efficiency of health care services. With the exponential rise in health care costs, health care authorities worldwide are expressing the urgent need to obtain information on health care performance.
0 kommentar(er)
