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Quality indicators used by trauma centers for performance measurement

Santana, Maria Jose MPharm, PhD; Stelfox, Henry T. MD, PhD

Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1298–1303
doi: 10.1097/TA.0b013e318246584c
Original Articles

BACKGROUND: To describe the quality indicators (QIs) that trauma centers use for quality measurement and performance improvement. Measuring and reporting quality of care is a critical step to improve the quality of care. QIs compare actual trauma care against ideal criteria and identify patients in whom care may have been suboptimal and should be further reviewed.

METHODS: Three hundred thirty verified trauma centers in the United States, Canada, Australia, and New Zealand had their websites reviewed and leadership surveyed regarding QI use. The indicators identified were classified according to definition specifications, phase of care, Institute of Medicine aims, and contents.

RESULTS: Two hundred fifty-one centers responded to the survey (76%) and the majority (97%) indicated that they use QIs. We obtained 10,587 QIs from 262 centers (survey responses and website review) of which 1,102 were unique indicators. The QIs primarily assessed the safety (49%), effectiveness (32%), efficiency (27%), and timeliness (22%) of hospital processes (64%) and outcomes (24%). The majority of indicators were used by a small number of centers (551 of 1,102 unique indicators used by single centers).

CONCLUSION: Our study provides the first description of the QIs used by verified trauma centers in four high-income countries with similar systems of trauma care. The majority of trauma centers measure QIs designed to examine the safety, effectiveness, efficiency, and timeliness of hospital processes and outcomes. Opportunities exist to standardize existing QIs to allow broader implementation and develop new QIs to examine patient-centered care and equality of care.

Calgary, Canada

From the Departments of Critical Care Medicine (H.T.S.) and Medicine and Community Health Sciences (M.J.S., H.T.S) and W21C Research and Innovation Center (M.J.S.), University of Calgary, Calgary, Alberta, Canada.

Submitted: July 7, 2011, Revised: November 9, 2011, Accepted: December 11, 2011.

Supported by Partnerships in Health System Improvement Grant (PHE-91429) from the Canadian Institutes of Health Research and Alberta Innovates. Supported by a New Investigator award from the Canadian Institutes of Health Research and a Population Health Investigator award form Alberta Innovates (to H.T.S).

Address for reprints: Maria Jose Santana, MPharm, PhD, W21C Research and Innovation Center, University of Calgary, GD-01, TRW Building, 3280 Hospital Drive, Calgary, Alberta, Canada T2N 4Z6; email:

© 2012 Lippincott Williams & Wilkins, Inc.