Abstract
Background
Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia–Pacific region.
Methods
We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21–22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia–Pacific.
Results
A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia–Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care.
Conclusions
Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia–Pacific region. In this study we identified opportunities for addressing these challenges, and that work will be supported by APTQIN.
Similar content being viewed by others
References
World Health Organization (2008) The global burden of disease. WHO, Geneva
Murray CJ, Lopez AD (1996) Global health statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions. Harvard University Press, Cambridge
The World Bank Group (2009) The World Bank Country Classification. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20420458~menuPK:64133156~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html. Accessed 13 May 2011
Murray CJ, Lopez AD (1997) Mortality by cause for eight regions of the world: global burden of disease study. Lancet 349(9061):1269–1276
Mock C, Joshipura M, Goosen J, Lormand JD, Maier R (2005) Strengthening trauma systems globally: the essential trauma care project. J Trauma 59:1243–1246
Juillard CJ, Mock C, Goosen J, Joshipura M, Civil I (2009) Establishing the evidence base for trauma quality improvement: a collaborative WHO-IATSIC review. World J Surg 33:1075–1086. doi:10.1016/j.amjsurg.2009.09.021
Chadbunchachai W, Saranrittichai S, Sriwiwat S, Chumsri J, Kulleab S, Jaikwang P (2003) Study on performance following key performance indicators for trauma care: Khon Kaen Hospital 2000. J Med Assoc Thai 86:1–7
Stelfox HT, Bobranska-Artiuch B, Nathens A, Straus SE (2010) Quality indicators for evaluating trauma care: a scoping review. Arch Surg 145:286–295
O’Cathain A, Murphy E, Nicholl J (2010) Three techniques for integrating data in mixed methods studies. Br Med J 341:c4587
Burns KE, Duffett M, Kho ME, Meade MO, Adhikari NK, Sinuff T, Cook DJ (2008) A guide for the design and conduct of self-administered surveys of clinicians. Can Med Assoc J 179:245–252
Pope C, Mays N (1999) Qualitative research in health care, 2nd edn. BMJ Books, London
Bryman A (2004) Social research methods, 2nd edn. Oxford University Press, Oxford
World Health Organization (2007) Working for health: an introduction to the World Health Organization. World Health Organization, Geneva
Australasian Trauma Society (2010) Trauma 2010. Crows Nest Publishing, New South Wales. http://traumasociety.com.au/meetings.html. Accessed 10 March 2011
Feinstein AR (1987) The theory and evaluation of sensibility. Clinimetrics, Yale University Press, New Haven, pp 141–166
Horn L, Tzanetos K, Thorpe K, Straus SE (2008) Factors associated with the subspecialty choices of internal medicine residents in Canada. BMC Med Educ 8:37
Jones J, Hunter D (1995) Consensus methods for medical and health services research. Br Med J 311(7001):376–380.
Strauss AL (2003) Qualitative analysis for social scientists. Cambridge University Press, Cambridge
World Health Organization (2012) Countries. http://www.who.int/countries/en/. Accessed 30 January 2012
World Health Organization (2010) Strengthening care for the injured: success stories and lessons learned from around the world. WHO, Geneva
Chadbunchachai W, Sriwiwat S, Kulleab S (2001) The comparative study for quality of trauma treatment before and after the revision of trauma audit filter, Khon Kaen Hospital 1998. J Med Assoc Thai 84:782–790
Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 44:804–812; discussion 812–814
Mock CN, Adzotor KE, Conklin E, Denno DM, Jurkovich GJ (1993) Trauma outcomes in the rural developing world: comparison with an urban level I trauma center. J Trauma 35:518–523
Maier RV, Rhodes M (2001) Trauma performance improvement. In: Rivara FP, Cummings P, Koepsell TD, Grossman DC, Maier RV (eds) Injury control. Cambridge University Press, Cambridge
Mock C, Joshipura M, Quansah R, Arreola-Risa C (2007) Advancing injury prevention and trauma care in North America and globally. Surg Clin N Am 87:1–19
World Health Organization (2004) Guidelines for essential trauma care. WHO, Geneva
Campbell R, Quilty B, Dieppe P (2003) Discrepancies between patients’ assessments of outcome: qualitative study nested within a randomised controlled trial. Br Med J 326(7383):252–253
Lewin S, Glenton C, Oxman AD (2009) Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. Br Med J 339:b3496
Adamson J, Ben-Shlomo Y, Chaturvedi N, Donovan J (2009) Exploring the impact of patient views on “appropriate” use of services and help seeking: a mixed method study. Br J Gen Pract 59(564):e226–e233
Acknowledgments
The authors are grateful to Charlie Mock for advice and support in planning the meeting and Ebony Gilbee for data collection. The project was supported by the Canadian Institutes of Health Research (Meeting Grant FRN-101999), the Australian Agency for International Development (AusAID) through its International Seminar Support Scheme, and the National Trauma Research Institute (NTRI) of Australia. The workshop was hosted by the NTRI and The Alfred Hospital. The Royal Australasian College of Surgeons provided the venue for the workshop. Dr. Stelfox is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates. Dr. Gruen is supported by a Career Development Award from the Australian National Health and Medical Research Council. Funding sources had no role in the design, conduct, or reporting of this study, and we are unaware of any conflicts of interest. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study. Drs. Stelfox and Gruen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A version of the manuscript was presented at the 2011 International Association for Trauma Surgery and Intensive Care (IATSIC) section of the International Surgical Society Meeting, Yokohama, Japan.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stelfox, H.T., Joshipura, M., Chadbunchachai, W. et al. Trauma Quality Improvement in Low and Middle Income Countries of the Asia–Pacific Region: A Mixed Methods Study. World J Surg 36, 1978–1992 (2012). https://doi.org/10.1007/s00268-012-1593-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-012-1593-1