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Br J Surg. 2012 Jan;99 Suppl 1:97-104. doi: 10.1002/bjs.7754.

Indicators of the quality of trauma care and the performance of trauma systems.

Author information

1
National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia. r.gruen@alfred.org.au

Abstract

BACKGROUND:

Valid and reliable measures of trauma system performance are needed to guide improvement activities, benchmarking and public reporting, future investment and research. Traditional measures of in-hospital mortality fail to take into account prehospital and posthospital care, recovery after discharge, and the nature and costs of long-term disability.

METHODS:

Drawing on recent systematic reviews, an overview was conducted of existing and emerging trauma care performance indicators. Changes in the nature and purpose of indicators were assessed.

RESULTS:

Among a large number of existing, mostly locally developed performance indicators, only peer review of deaths has evidence of validity or reliability. The usefulness of the traditional performance measure of in-hospital mortality has been challenged. There is an emerging shift in focus from mortality to non-mortality outcomes, from hospital-based to long-term community-based outcome assessment, and from single measures of trauma centre performance to measures better suited to monitoring the performance of systems of care spanning the entire patient journey. As a result, a new generation of indicators is emerging that are both feasible and potentially more useful for commissioners and payers of population-based services.

CONCLUSION:

A global endeavour is now under way to agree on a set of standardized performance indicators that are meaningful to patients, carers, clinicians, managers and service funders, are likely to contribute to desired outcomes, and are valid, reliable and have a strong evidence base.

PMID:
22441862
DOI:
10.1002/bjs.7754
[Indexed for MEDLINE]
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