Comparing treatment of pediatric injury by hospital type or physician expertise has often created more controversy than conformity. Three key components that help define quality of care include infrastructure, process, and outcome. This report highlights studies that compared processes of care by physician and hospital expertise with regard to injured children. During the past 15 years, numerous studies have compared both hospital and physician expertise in the processes of pediatric trauma care. From these studies, it is clear that evaluation of processes of care is equally important as evaluating outcome, especially when mortality is the outcome variable. Future studies should examine other aspects of care in addition to surgical processes that might impact either rates of complications or long-term outcomes.
From the Department of Pediatric Surgery (S.S.), Miami Children's Hospital, Miami, Florida; and Division of General Surgery and Trauma (A.B.N.), St. Michael's Hospital, University of Toronto, Toronto, Canada.
Submitted for publication August 1, 2007.
Accepted for publication August 6, 2007.
Dr. Stylianos is supported in part by Grant #HO3MC0006 from the Department of Health and Human Services, Maternal and Child Health Bureau; the APSA Foundation; and the Arnold P. Gold Foundation. Dr. Nathens' is supported by a Canada Research Chair in Systems of Trauma.
Presented at the Pediatric Trauma Care Workshop on Costs and Outcomes, Washington, DC, March 8–9, 2007.
Address for reprints: Steven Stylianos, MD, Miami Children's Hospital, 3200 SW 60th Court-Suite 201, Miami, FL 33155; email: firstname.lastname@example.org.