Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on

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dc.contributor.authorLaGrone, Lacey N .
dc.contributor.authorRomaní, Diego
dc.contributor.authorFigueroa, Juan F.
dc.contributor.authorArtunduaga, Maria A.
dc.contributor.authorHuamán Egoávil, Eduardo
dc.contributor.authorRodríguez-Castro, Manuel J.A.
dc.contributor.authorFoianini, Jorge Esteban
dc.contributor.authorRubiano, Andrés M.
dc.contributor.authorRodas, Edgar B.
dc.contributor.authorMock, Charles N.
dc.contributor.orcidRubiano, Andrés M. [0000-0001-8931-3254]
dc.date.accessioned2020-07-09T19:11:27Z
dc.date.available2020-07-09T19:11:27Z
dc.description.abstractenglishIntroduction Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs. Methods We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru. Results 336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent – 45% occurred less than every three months and poorly attended – 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation – notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16–10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73–19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59–14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice. Conclusions M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1016/j.injury.2017.03.003
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.issn1879-0267
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlhttps://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/3387
dc.language.isoeng
dc.publisherElsevierspa
dc.publisher.journalInjuryspa
dc.relation.ispartofseriesInjury. 1879-0267, Vol. 48, Nro. 9, 2017, p. 1985-1993spa
dc.relation.urihttps://www.sciencedirect.com/science/article/abs/pii/S0020138317301365
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf2
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightsAcceso abierto
dc.rights.creativecommons2017-09-01
dc.rights.localAcceso abiertospa
dc.subject.decsHeridas y traumatismosspa
dc.subject.decsAutopsiaspa
dc.subject.decsAnálisis costo-beneficiospa
dc.subject.keywordsLatin Americaspa
dc.subject.keywordsQuality improvementspa
dc.subject.keywordsSurgeryspa
dc.titleStatus of trauma quality improvement programs in the Andean region: What foundation do we have to build onspa
dc.title.translatedStatus of trauma quality improvement programs in the Andean region: What foundation do we have to build onspa
dc.type.coarhttps://purl.org/coar/resource_type/c_6501
dc.type.driverinfo:eu-repo/semantics/article
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localArtículo de revista

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