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

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dc.contributor.author LaGrone, Lacey N.
dc.contributor.author Romani Pozo, Diego A.
dc.contributor.author Figueroa, Juan F.
dc.contributor.author Artunduaga, Maria A.
dc.contributor.author Huaman Egoavil, Eduardo
dc.contributor.author Rodriguez Castro, Manuel J. A.
dc.contributor.author Foianini, Jorge Esteban
dc.contributor.author Rubiano, Andres M.
dc.contributor.author Rodas, Edgar B.
dc.contributor.author Mock, Charles N.
dc.date.accessioned 2019-01-25T16:03:21Z
dc.date.available 2019-01-25T16:03:21Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4766
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1879-0267
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Bolivia/epidemiology en_US
dc.subject Colombia/epidemiology en_US
dc.subject Cost-Benefit Analysis en_US
dc.subject Cross-Sectional Studies en_US
dc.subject Ecuador/epidemiology en_US
dc.subject Humans en_US
dc.subject Latin America en_US
dc.subject Morbidity and mortality meeting en_US
dc.subject Peru/epidemiology en_US
dc.subject Process Assessment (Health Care) en_US
dc.subject Program Development en_US
dc.subject Quality improvement en_US
dc.subject Quality Improvement/organization & administration en_US
dc.subject Registry en_US
dc.subject Surgery en_US
dc.subject Trauma en_US
dc.subject Trauma Centers/organization & administration/standards en_US
dc.subject Wounds and Injuries/therapy en_US
dc.title Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.injury.2017.03.003
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.11
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.11

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