Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on
复制标题
DOI：
10.1016/j.injury.2017.03.003
复制
发表时间：
2017-09-01
影响因子：
2.5
通讯作者：
Mock, Charles N.
中科院分区：
文献类型：
--
作者：
LaGrone, Lacey N.;Romani Pozo, Diego A.;Mock, Charles N.
引言：创伤质量改善（QI）计划已被证明可以改善结局并降低成本。这些都是低收入和中等收入国家的高度优先事项，每年有200万人死于可存活的伤害。我们试图确定在四个LMICs.Methods创伤QI程序改进的领域：我们在四个安第斯中等收入国家的创伤护理提供者中进行了一项调查：玻利维亚、哥伦比亚、厄瓜多尔和秘鲁。在除玻利维亚以外的所有纳入国家，336名医生、医科学生、护士、行政人员和辅助医疗专业人员对横断面调查作出了答复，答复率超过90%，回答率是14%。87%的受访者报告发病率和死亡率（M&M）会议发生在他们的医院。会议经常被报告为不频繁-45%的会议少于每三个月举行一次，出席率很低-63%的会议有五名或更少的医生出席。只有23%的会议有标准化的选择标准，大多数会议缺乏文件记录，只有35%的会议做了笔记。重要的是，只有13%的参与者表示，讨论定期跟进任何形式的纠正措施。多变量分析显示，标准化病例选择标准（OR 3.48，95%CI 1.16-10.46）、M&M会议的书面文件（OR 5.73，95%CI 1.73-19.06）和明确的随访计划（OR 4.80，95%CI 1.59-14.50）与有效的M&M会议相关。22%的受访者在有创伤登记的医院工作。百分之五十二的工作机构进行尸检，但只有32%的人报告的尸检结果，以往任何时候都被用来改善医院practice.Conclusions：M&M会议经常在拉丁美洲安第斯地区实行，但往往缺乏方法的严谨性，从而有效性。QI计划成熟的下一步包括优化尸检和登记数据的使用，以及对M&M会议进行系统的后续纠正措施，以确保这些活动导致临床护理的明显变化。(C)2017爱思唯尔有限公司版权所有
Introduction: 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. (C) 2017 Elsevier Ltd. All rights reserved.