Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on
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 Q...
- Autores:
-
LaGrone, Lacey N .
Romaní, Diego
Figueroa, Juan F.
Artunduaga, Maria A.
Huamán Egoávil, Eduardo
Rodríguez-Castro, Manuel J.A.
Foianini, Jorge Esteban
Rubiano, Andrés M.
Rodas, Edgar B.
Mock, Charles N.
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2020
- Institución:
- Universidad El Bosque
- Repositorio:
- Repositorio U. El Bosque
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.unbosque.edu.co:20.500.12495/3387
- Acceso en línea:
- http://hdl.handle.net/20.500.12495/3387
https://doi.org/10.1016/j.injury.2017.03.003
https://repositorio.unbosque.edu.co
- Palabra clave:
- Heridas y traumatismos
Autopsia
Análisis costo-beneficio
Latin America
Quality improvement
Surgery
- Rights
- openAccess
- License
- Acceso abierto
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|
dc.title.spa.fl_str_mv |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
dc.title.translated.spa.fl_str_mv |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
title |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
spellingShingle |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on Heridas y traumatismos Autopsia Análisis costo-beneficio Latin America Quality improvement Surgery |
title_short |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
title_full |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
title_fullStr |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
title_full_unstemmed |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
title_sort |
Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on |
dc.creator.fl_str_mv |
LaGrone, Lacey N . Romaní, Diego Figueroa, Juan F. Artunduaga, Maria A. Huamán Egoávil, Eduardo Rodríguez-Castro, Manuel J.A. Foianini, Jorge Esteban Rubiano, Andrés M. Rodas, Edgar B. Mock, Charles N. |
dc.contributor.author.none.fl_str_mv |
LaGrone, Lacey N . Romaní, Diego Figueroa, Juan F. Artunduaga, Maria A. Huamán Egoávil, Eduardo Rodríguez-Castro, Manuel J.A. Foianini, Jorge Esteban Rubiano, Andrés M. Rodas, Edgar B. Mock, Charles N. |
dc.contributor.orcid.none.fl_str_mv |
Rubiano, Andrés M. [0000-0001-8931-3254] |
dc.subject.decs.spa.fl_str_mv |
Heridas y traumatismos Autopsia Análisis costo-beneficio |
topic |
Heridas y traumatismos Autopsia Análisis costo-beneficio Latin America Quality improvement Surgery |
dc.subject.keywords.spa.fl_str_mv |
Latin America Quality improvement Surgery |
description |
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. |
publishDate |
2020 |
dc.date.accessioned.none.fl_str_mv |
2020-07-09T19:11:27Z |
dc.date.available.none.fl_str_mv |
2020-07-09T19:11:27Z |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coarversion.fl_str_mv |
http://purl.org/coar/version/c_970fb48d4fbd8a85 |
dc.type.local.none.fl_str_mv |
Artículo de revista |
dc.type.coar.none.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.type.driver.none.fl_str_mv |
info:eu-repo/semantics/article |
format |
http://purl.org/coar/resource_type/c_6501 |
dc.identifier.issn.none.fl_str_mv |
1879-0267 |
dc.identifier.uri.none.fl_str_mv |
http://hdl.handle.net/20.500.12495/3387 |
dc.identifier.doi.none.fl_str_mv |
https://doi.org/10.1016/j.injury.2017.03.003 |
dc.identifier.instname.spa.fl_str_mv |
instname:Universidad El Bosque |
dc.identifier.reponame.spa.fl_str_mv |
reponame:Repositorio Institucional Universidad El Bosque |
dc.identifier.repourl.none.fl_str_mv |
https://repositorio.unbosque.edu.co |
identifier_str_mv |
1879-0267 instname:Universidad El Bosque reponame:Repositorio Institucional Universidad El Bosque |
url |
http://hdl.handle.net/20.500.12495/3387 https://doi.org/10.1016/j.injury.2017.03.003 https://repositorio.unbosque.edu.co |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartofseries.spa.fl_str_mv |
Injury. 1879-0267, Vol. 48, Nro. 9, 2017, p. 1985-1993 |
dc.relation.uri.none.fl_str_mv |
https://www.sciencedirect.com/science/article/abs/pii/S0020138317301365 |
dc.rights.local.spa.fl_str_mv |
Acceso abierto |
dc.rights.accessrights.none.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 info:eu-repo/semantics/openAccess Acceso abierto |
dc.rights.creativecommons.none.fl_str_mv |
2017-09-01 |
rights_invalid_str_mv |
Acceso abierto http://purl.org/coar/access_right/c_abf2 2017-09-01 |
eu_rights_str_mv |
openAccess |
dc.format.mimetype.none.fl_str_mv |
application/pdf |
dc.publisher.spa.fl_str_mv |
Elsevier |
dc.publisher.journal.spa.fl_str_mv |
Injury |
institution |
Universidad El Bosque |
bitstream.url.fl_str_mv |
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spelling |
LaGrone, Lacey N .Romaní, DiegoFigueroa, Juan F.Artunduaga, Maria A.Huamán Egoávil, EduardoRodríguez-Castro, Manuel J.A.Foianini, Jorge EstebanRubiano, Andrés M.Rodas, Edgar B.Mock, Charles N.Rubiano, Andrés M. [0000-0001-8931-3254]2020-07-09T19:11:27Z2020-07-09T19:11:27Z1879-0267http://hdl.handle.net/20.500.12495/3387https://doi.org/10.1016/j.injury.2017.03.003instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquehttps://repositorio.unbosque.edu.coapplication/pdfengElsevierInjuryInjury. 1879-0267, Vol. 48, Nro. 9, 2017, p. 1985-1993https://www.sciencedirect.com/science/article/abs/pii/S0020138317301365Status of trauma quality improvement programs in the Andean region: What foundation do we have to build onStatus of trauma quality improvement programs in the Andean region: What foundation do we have to build onArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articlehttp://purl.org/coar/version/c_970fb48d4fbd8a85Heridas y traumatismosAutopsiaAnálisis costo-beneficioLatin AmericaQuality improvementSurgeryIntroduction 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.Acceso abiertohttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessAcceso abierto2017-09-01ORIGINALLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdfLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdfapplication/pdf374836https://repositorio.unbosque.edu.co/bitstreams/1a0d5705-2437-4db2-a03f-18320b30be0c/download8360cfd770c78d348534cf27e6f0c39cMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorio.unbosque.edu.co/bitstreams/8eddae39-a2b7-4079-b813-4bc1f7add8a5/download8a4605be74aa9ea9d79846c1fba20a33MD52THUMBNAILLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdf.jpgLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdf.jpgimage/jpeg5775https://repositorio.unbosque.edu.co/bitstreams/c0016a60-331a-4389-88d8-7565ac17c8a3/download7210a811635d1799e7c05fee5d259be7MD53TEXTLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdf.txtLacey N. LaGrone aDiego A. Romaní Pozo bJuan F. Figueroa cMaria A. Artunduaga _2017.pdf.txtExtracted texttext/plain52527https://repositorio.unbosque.edu.co/bitstreams/26ae60c1-acf2-4237-826a-569734243451/downloadd72485a65e8ae51b115b7e83f3363f8bMD5420.500.12495/3387oai:repositorio.unbosque.edu.co:20.500.12495/33872024-02-07 05:06:06.065restrictedhttps://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.comTk9URTogUExBQ0UgWU9VUiBPV04gTElDRU5TRSBIRVJFClRoaXMgc2FtcGxlIGxpY2Vuc2UgaXMgcHJvdmlkZWQgZm9yIGluZm9ybWF0aW9uYWwgcHVycG9zZXMgb25seS4KCk5PTi1FWENMVVNJVkUgRElTVFJJQlVUSU9OIExJQ0VOU0UKCkJ5IHNpZ25pbmcgYW5kIHN1Ym1pdHRpbmcgdGhpcyBsaWNlbnNlLCB5b3UgKHRoZSBhdXRob3Iocykgb3IgY29weXJpZ2h0Cm93bmVyKSBncmFudHMgdG8gRFNwYWNlIFVuaXZlcnNpdHkgKERTVSkgdGhlIG5vbi1leGNsdXNpdmUgcmlnaHQgdG8gcmVwcm9kdWNlLAp0cmFuc2xhdGUgKGFzIGRlZmluZWQgYmVsb3cpLCBhbmQvb3IgZGlzdHJpYnV0ZSB5b3VyIHN1Ym1pc3Npb24gKGluY2x1ZGluZwp0aGUgYWJzdHJhY3QpIHdvcmxkd2lkZSBpbiBwcmludCBhbmQgZWxlY3Ryb25pYyBmb3JtYXQgYW5kIGluIGFueSBtZWRpdW0sCmluY2x1ZGluZyBidXQgbm90IGxpbWl0ZWQgdG8gYXVkaW8gb3IgdmlkZW8uCgpZb3UgYWdyZWUgdGhhdCBEU1UgbWF5LCB3aXRob3V0IGNoYW5naW5nIHRoZSBjb250ZW50LCB0cmFuc2xhdGUgdGhlCnN1Ym1pc3Npb24gdG8gYW55IG1lZGl1bSBvciBmb3JtYXQgZm9yIHRoZSBwdXJwb3NlIG9mIHByZXNlcnZhdGlvbi4KCllvdSBhbHNvIGFncmVlIHRoYXQgRFNVIG1heSBrZWVwIG1vcmUgdGhhbiBvbmUgY29weSBvZiB0aGlzIHN1Ym1pc3Npb24gZm9yCnB1cnBvc2VzIG9mIHNlY3VyaXR5LCBiYWNrLXVwIGFuZCBwcmVzZXJ2YXRpb24uCgpZb3UgcmVwcmVzZW50IHRoYXQgdGhlIHN1Ym1pc3Npb24gaXMgeW91ciBvcmlnaW5hbCB3b3JrLCBhbmQgdGhhdCB5b3UgaGF2ZQp0aGUgcmlnaHQgdG8gZ3JhbnQgdGhlIHJpZ2h0cyBjb250YWluZWQgaW4gdGhpcyBsaWNlbnNlLiBZb3UgYWxzbyByZXByZXNlbnQKdGhhdCB5b3VyIHN1Ym1pc3Npb24gZG9lcyBub3QsIHRvIHRoZSBiZXN0IG9mIHlvdXIga25vd2xlZGdlLCBpbmZyaW5nZSB1cG9uCmFueW9uZSdzIGNvcHlyaWdodC4KCklmIHRoZSBzdWJtaXNzaW9uIGNvbnRhaW5zIG1hdGVyaWFsIGZvciB3aGljaCB5b3UgZG8gbm90IGhvbGQgY29weXJpZ2h0LAp5b3UgcmVwcmVzZW50IHRoYXQgeW91IGhhdmUgb2J0YWluZWQgdGhlIHVucmVzdHJpY3RlZCBwZXJtaXNzaW9uIG9mIHRoZQpjb3B5cmlnaHQgb3duZXIgdG8gZ3JhbnQgRFNVIHRoZSByaWdodHMgcmVxdWlyZWQgYnkgdGhpcyBsaWNlbnNlLCBhbmQgdGhhdApzdWNoIHRoaXJkLXBhcnR5IG93bmVkIG1hdGVyaWFsIGlzIGNsZWFybHkgaWRlbnRpZmllZCBhbmQgYWNrbm93bGVkZ2VkCndpdGhpbiB0aGUgdGV4dCBvciBjb250ZW50IG9mIHRoZSBzdWJtaXNzaW9uLgoKSUYgVEhFIFNVQk1JU1NJT04gSVMgQkFTRUQgVVBPTiBXT1JLIFRIQVQgSEFTIEJFRU4gU1BPTlNPUkVEIE9SIFNVUFBPUlRFRApCWSBBTiBBR0VOQ1kgT1IgT1JHQU5JWkFUSU9OIE9USEVSIFRIQU4gRFNVLCBZT1UgUkVQUkVTRU5UIFRIQVQgWU9VIEhBVkUKRlVMRklMTEVEIEFOWSBSSUdIVCBPRiBSRVZJRVcgT1IgT1RIRVIgT0JMSUdBVElPTlMgUkVRVUlSRUQgQlkgU1VDSApDT05UUkFDVCBPUiBBR1JFRU1FTlQuCgpEU1Ugd2lsbCBjbGVhcmx5IGlkZW50aWZ5IHlvdXIgbmFtZShzKSBhcyB0aGUgYXV0aG9yKHMpIG9yIG93bmVyKHMpIG9mIHRoZQpzdWJtaXNzaW9uLCBhbmQgd2lsbCBub3QgbWFrZSBhbnkgYWx0ZXJhdGlvbiwgb3RoZXIgdGhhbiBhcyBhbGxvd2VkIGJ5IHRoaXMKbGljZW5zZSwgdG8geW91ciBzdWJtaXNzaW9uLgo= |