Building Capacity for Trauma Quality Improvement: An Innovative Pilot Program in Cameroon to Address the Burden of Injury

提高创伤质量的能力建设：喀麦隆解决伤害负担的创新试点计划

• 批准号: 9766432
• 负责人: Alain Mefire Chichom
• 金额: $ 15.17万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-11-19 至 2021-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766432
• 关键词: Address; Affect; Africa South of the Sahara; Awareness; California; Cameroon; Caring; Cessation of life; Clinical; Collaborations; Committee Members; Country; Data; Data Collection; Data Quality; Development; Evaluation; Event; Foundations; Future; Goals; HIV; Health system; Income; Individual; Injury; Intervention; Leadership; Malaria; Measures; Methodology; Methods; Mission; Modeling; Monitor; Nurses; Outcome; Patient Care; Patients; Physicians; Plant Roots; Population; Preparation; Procedures; Process; Public Health; Quality of Care; Recommendation; Registries; Research; Resources; San Francisco; Scientist; Supervision; System; Techniques; Training; Trauma; Trauma patient; Tuberculosis; United States National Institutes of Health; Universities; Work; base; care delivery; clinical care; data registry; design; disability; evidence base; improved; injured; injury burden; innovation; low and middle-income countries; meetings; novel; peer; practical application; programs; public health priorities; skills; tool; trauma care; treatment strategy

Project Summary/Abstract As injuries become an increasingly important public health priority in low- and middle-income settings, including sub-Saharan Africa (SSA), context-appropriate methodologies for developing improvements in systems of trauma care are lacking. Although several pilot trauma registries have been created in SSA, correlative processes to use registry data for injury control interventions, like trauma quality improvement (QI), are urgently needed. Without appropriate methodology, trauma registries and other surveillance tools in SSA will remain powerless to create actionable change. Cameroon appears to be more affected by injury than other countries in the region. Our long-term goal is to reduce the impact of injury in Cameroon and other parts of SSA through development of an integrated trauma system, of which trauma QI is a key component. The overall objective of this application is to build on an existing centralized trauma registry by developing trauma QI methodology appropriate for the Cameroonian context and generalizable to other similar SSA settings, which is the next step toward attainment of our long-term goal. Using trauma registries to develop QI processes and interventions will provide a direct mechanism for improved patient care that will be exportable to other similar SSA settings and other health systems for non-communicable diseases or injury control. To accomplish the objective of this application, we will pursue four specific aims: 1) Establish and train a peer-driven trauma care QI committee in Cameroon that can perform comprehensive case review and root cause analysis to identify specific correctable deficiencies; 2) Train four “QI fellows” and a QI program manager to develop research and analytic skills in QI methodology, monitoring, and evaluation; 3) Apply the QI process to refine the existing trauma registry data collection tool, enhancing its capacity to capture changes in the quality of clinical care delivery; and 4) Implement QI committee meetings to propose context-appropriate trauma QI interventions for future implementation in Cameroon and similar settings. This contribution will create novel, locally-relevant trauma QI methods and context-appropriate treatment strategies that can be implemented in Cameroon and other SSA countries with the expected result of improving trauma care and injury control. These QI methods and treatment strategies will serve as a “roadmap” for how to use trauma registry data and QI methodology to improve clinical trauma care through actionable interventions that are targeted, evidence-based, and context- appropriate. The development of a culturally-relevant, peer-driven comprehensive QI process is novel. Embedded in our approach is the training of clinicians in the process of QI and the scientific methods by which to conduct QI analysis. This research initiative is the vital step towards ultimately creating a core group of clinician scientists with the skills to disseminate the QI process, and developing a network of individuals who can create a culture of research-based improvements in the care of the injured.

项目总结/摘要 随着伤害成为中低收入环境中日益重要的公共卫生优先事项， 包括撒哈拉以南非洲在内的非洲国家， 缺乏创伤护理系统。虽然在SSA已经建立了几个飞行员创伤登记处， 使用登记数据进行伤害控制干预的相关过程，如创伤质量改善（QI）， 是迫切需要的。如果没有适当的方法，SSA中的创伤登记和其他监测工具 将仍然无力创造可操作的改变。喀麦隆似乎比其他国家更容易受到伤病的影响。 该地区的国家。我们的长期目标是减少喀麦隆和其他地区受伤的影响， SSA通过发展一个综合的创伤系统，其中创伤气是一个关键组成部分。整体 本应用程序的目的是通过开发创伤QI，在现有的集中创伤登记处的基础上进行开发 方法适用于爱沙尼亚的背景和推广到其他类似的SSA设置，这是 实现我们长期目标的下一步。使用创伤登记来开发QI流程， 干预措施将为改善患者护理提供直接机制， 用于非传染性疾病或伤害控制的SSA环境和其他卫生系统。完成 本申请的目的，我们将追求四个具体目标：1）建立和培训一个同行驱动的创伤护理 喀麦隆的QI委员会，可以进行全面的案例审查和根本原因分析， 具体可纠正的缺陷; 2）培训四名“QI研究员”和一名QI项目经理，以开展研究， QI方法、监测和评估的分析技能; 3）应用QI过程来完善现有的 创伤登记数据收集工具，提高其捕捉临床护理质量变化的能力 交付;以及4）实施QI委员会会议，以提出适当的创伤QI干预措施， 在喀麦隆和类似情况下的未来实施。这一贡献将创造新颖的，与当地有关的 可以在喀麦隆实施的创伤QI方法和适合具体情况的治疗策略， 其他撒哈拉以南非洲国家，预期结果是改善创伤护理和伤害控制。这些气功方法 和治疗策略将作为如何使用创伤登记数据和QI方法的“路线图”， 通过有针对性的、基于证据的和有背景的可操作的干预措施来改善临床创伤护理， 适当一个文化相关的，同行驱动的全面QI过程的发展是新颖的。 嵌入在我们的方法是培训临床医生的过程中的QI和科学的方法， 进行QI分析。这一研究举措是朝着最终建立一个核心小组迈出的重要一步， 具有传播QI过程技能的临床科学家，并建立一个个人网络， 可以创造一种以研究为基础的文化，改善对受伤者的护理。

项目成果

Evaluating Shifts in Perception After a Pilot Trauma Quality Improvement Training Course in Cameroon.

评估喀麦隆飞行员创伤质量改进培训课程后认知的转变。

• DOI: 10.1016/j.jss.2022.02.019
• 发表时间: 2022
• 期刊: The Journal of surgical research
• 作者: Nguyen,NicoleT;Ding,Kevin;Oke,Rasheedat;Tanjong,Mary-MagdaleneS;Mbuh,Lidwine;Mbianyor,MbiarikaiA;Carvalho,Melissa;DissakDelon,FannyNadia;Boeck,Marissa;Collins,Caitlin;Yenshu,EmmanuelV;Etoundi,GeorgeAlain;Juillard,Catherine

Baseline Patient Safety Culture in Cameroon: Setting a Foundation for Trauma Quality Improvement.

• DOI: 10.1016/j.jss.2020.05.068
• 发表时间: 2020-11
• 期刊: The Journal of surgical research
• 作者: Ding K;Nguyen N;Carvalho M;Dissak Delon FN;Mekolo D;Nkusu D;Tchekep MS;Oke RA;Mbianyor MA;Yenshu EV;Boeck M;Collins C;Jackson N;Mefire AC;Juillard C
• 通讯作者: Juillard C

How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement.

创伤患者如何在资源匮乏的环境中死亡：确定创伤质量改善的早期目标。

• DOI: 10.1097/ta.0000000000003768
• 发表时间: 2023
• 期刊: The journal of trauma and acute care surgery
• 作者: Christie,SAriane;Zheng,Dennis;Dissak-Delon,Fanny;Kinge,Thompson;Njock,Richard;Nkusu,Daniel;Tsiagadigui,Jean-Gustave;Mbianyor,Mbiarikai;Dicker,Rochelle;Chichom-Mefire,Alain;Juillard,Catherine
• 通讯作者: Juillard,Catherine