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Development and Evaluation of Evidence-Informed Quality Indicators for Adult Injury Care

Santana, Maria J. MPharm, PhD*; Stelfox, Henry T. MD, PhD, FRCPC; on behalf of the Trauma Quality Indicator Consensus Panel

doi: 10.1097/SLA.0b013e31828df98e
Original Articles

Objective: To develop and evaluate evidence-informed quality indicators of adult injury care.

Background: Injury is a leading cause of morbidity and mortality, but there is a lack of consensus regarding how to evaluate injury care.

Methods: Using a modification of the RAND/UCLA Appropriateness Methodology, a panel of 19 injury and quality of care experts serially rated and revised quality indicators identified from a systematic review of the literature and international audit of trauma center quality improvement practices. The quality indicators developed by the panel were sent to 133 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation.

Results: A total of 84 quality indicators were rated and revised by the expert panel over 4 rounds of review producing 31 quality indicators of structure (n = 5), process (n = 21), and outcome (n = 5), designed to assess the safety (n = 8), effectiveness (n = 17), efficiency (n = 6), timeliness (n = 16), equity (n = 2), and patient-centeredness (n = 1) of injury care spanning prehospital (n = 8), hospital (n = 19), and posthospital (n = 2) care and secondary injury prevention (n = 1). A total of 101 trauma centers (76% response rate) rated the indicators (1 = strong disagreement, 9 = strong agreement) as targeting important health improvements (median score 9, interquartile range [IQR] 8–9), easy to interpret (median score 8, IQR 8–9), easy to implement (median score 8, IQR 7–8), and globally good indicators (median score 8, IQR 8–9).

Conclusions: Thirty-one evidence-informed quality indicators of adult injury care were developed, shown to have content validity, and can be used as performance measures to guide injury care quality improvement practices.

Injury is a leading cause of morbidity and mortality, but there is a lack of consensus regarding how to evaluate injury care. Thirty-one evidence-informed quality indicators of adult injury care were developed, shown to have content validity, and can be used as performance measures to guide quality improvement practices.

*Department of Community Health Sciences, W21C Research and Innovation Centre, Institute for Public Health, University of Calgary

Departments of Critical Care Medicine, Medicine and Community Health Sciences, Institute for Public Health, University of Calgary and Alberta Health Services.

Reprints: Henry Thomas Stelfox, MD, PhD, FRCPC, Teaching Research and Wellness Building, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. E-mail: tstelfox@ucalgary.ca.

The authors in the Trauma Quality Indicator Consensus Panel are listed in alphabetical order at under the “Acknowledgment” section.

Disclosure: Financial support was given by the Canadian Institutes for Health Research, Alberta Innovates-Health Solutions. The authors declare no conflicts of interest.

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© 2014 by Lippincott Williams & Wilkins.