Willis, C. D., Stoelwinder, J. U., & Cameron, P. A. (2008). Interpreting process indicators in trauma care: construct validity versus confounding by indication. Int J Qual Health Care, 20(5),331-8.
Quality indicators have found increased use in health systems based on a widely held assumption that QIs is a compelling indicator of the outcome of care. Accordingly, Willis and colleagues sought to assess the construct validity involving 14 trauma QIs by exploring their ability to detect those patients who were faced with the risk of poor outcomes, such as enhanced utilization of ICU, prolonged lengths of stay, and increased mortality. The research design for this particular study involved a review of data on blunt injury patients between 15 and 16 years from the Victorian State Trauma Registry. The study was interested in the data of the patients between 2001 (January) and 2006 (March). To facilitate an adjustment for significant covariates, use was made of logistic regression and univariate analyses. The study accounted for some 1504 cases. The results implicated three QIs with enhanced mortality, while a further three were associated with enhanced length of stay. All the other QIs demonstrated either no significant connections or lowered risks of poor effects. As a result, the authors concluded that the QIs under assessment was a depiction of poor constructs validity, along with lowered expediency in forecasting results.
Stelfox, H. T., Artiuch, B. B., Nathens, A.,& Straus, S. E. (2010). Quality Indicators for Evaluating Trauma Care. Arch Surg,145(3), 286-295.
The objective of this particular study was to methodically assess quality indicators literature for QIs identification, trauma care evaluation, mapping the definitions of QIs, and evaluating the available literature that appears to support QIs. The authors searched EMBASE, MEDLINE, and CINAHL databases, among others. For purpose of data extraction, the authors selected all the articles that had either proposed or identified QIs in helping to assess the quality of care that major traumatic injury patients received.
The search into literature helps to reveal 6869 citations. The literature included 538 full-text articles, 192 reviewed peer articles, 37 narrative reviews, and 55 cohort studies, among others. The study further helped to reveal 1572 incidences of QIs, all of which were grouped into 8 classes: audit filters, trauma center, patient safety indicators, peer review, ACS-COT, the outcome of care benchmarks, and guideline adherence. Hospital processes emerged as the most popular QIs with a score of 60.4 %. On the other hand, outcomes accounted for 22.6% of the score. This led the authors to conclude that there lacks strong evidence to support the many QIs that have been proposed on the assessment of the quality of trauma care.
Wisborg, T., Brattebø, G., Brinchmann-Hansen, Å., Per Einar, U., & Schrøder, H. (2008). Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals. Journal of Trauma-Injury Infection & Critical Care, 64(6), 1613-1618
In their study Wisborg and colleagues endeavored to examine the impact of training on the confidence, knowledge, as well as perceived team performance of the participants. The study’s methodology entailed requesting the 4,203 participants (55% nurses and 28% physicians) to fill up anonymously written questionnaires prior to and upon the completion of training courses, in a total of 44 hospitals in Norway. In addition, the study also included some 1,368 members of the team in 26 of the hospitals 6 months following the completion of their last training.
According to the results of this particular study, it emerged that all the participants had demonstrated significant improvements in their confidence levels as well as self-reported knowledge. Accordingly, the study reached a conclusion that practical team training as practiced at the hospital setting is vital as they help to enhance the confidence and perceived knowledge of the participants, which was demonstrated to have improved for a period of 6 months following the end of the training session.
Cameron, P., Cameron, P., & Stoelwinder, J. (2007). Quality indicators in trauma: Using data to monitor the quality of care. Web.
In this project, the authors intended to evaluate the validity of trauma process measures via the application of routinely collected and high-quality sources. Data for this particular study’s analysis was obtained from the Victorian State Trauma registry. Using regression methods, the researchers were able to evaluate this association, in addition to focusing on ICU use and length of stay. In its second phase, the project evaluated the application of multiple trauma indicators in the hospital setting. Research findings revealed limited association of the process measures with outcomes, in which there was a correlation between poorer patient outcomes and better performance. The research findings suggest that a strong correlation between in-hospital mortality with overall performance, implicating the need for a further investigation of this issue in order to create measures with enhanced validity.
Willis, C. D., Gabbe, B. J., & Cameron, P. A. (2007). Measuring quality in trauma care. Injury, 38(5), 527-37.
In this review, the authors have demonstrated the need for quality indicators to fulfill a few criteria, in order for it to become useful in quality measurement: a documented association between the outcome and the quality indicator, the ability of the indicator to assess the acceptable practice at that particular moment, the need to precisely define the target population, the application of a suitable risk adjustment strategy, the need to have feasible indicators for collection purposes, and the need to ensure that the measure applies to groups of people sufficient enough to enable it yield an index of the system-wide quality. The article further examines the application of QIs by health care personnel in caring for patients with trauma. In addition, the article also seeks to examine a number of QIs as used by several studies in the United States to determine trauma systems. In this regard, the article reveals that while some of these studies have been seen to advocate for the implementation of a number of definite indicators, on the other hand, there are still other studies whose recommendation seeks to have the proposed QIs discontinued.
Willis, C. D., Evans, S. M., Stoelwinder, J. U., & Cameron, P. A. (2007). Measuring quality. Aust Health Rev, 31(2), 276-81
In this article, Willis et al argue that hare cares professional and not only now required to ensure that patients get the high-quality health care that they deserve, but it is also a requirement that they are in a position to show they are fulfilling and presumably, exceeding the quality targets that have been established. The authors, therefore, show how quality indicators are a useful tool to health care professionals because they enable them to assess and measure quality. The article has also explored the benefits and drawbacks that are often associated with indicator measurements. Besides, the authors have talked of the need to ensure that the health care professionals find a balance between managerial control and the clinical perspective during the process of designing reliable, valid, specific and sensitive QIs. Willis et al have also argued that even as indicators may not symbolize the perfect measurement tool nonetheless they are still a vital tool for enhancing the safety of patients, in addition to assisting the health care professionals to fulfill the expectations of the community.
Lin, H., Chen, C., Lee, W., Kuo, L., Cheng, Y., Lin, Y., Lin, J., & Chan, H. (2009). Effects of the Emergency Trauma Training Course on the Confidence of Final-Year Medical Students Dealing with Trauma Patients. The Kaohsiung Journal of Medical Sciences, 25(1), 10-15
Although trauma is a significant issue, nevertheless, it has been neglected during the training sessions of medical students. Accordingly, the authors of this article endeavored to examine the impact of ETTC (Emergency Trauma Training Course) on medical students in their seventh year of study, following successful completion of the standard training in the medical field. The study involved 150 participants. The ANOVA (analysis of variance) measurement was used to determine the self-confidence levels of medical students following a training course on trauma. The research findings revealed profound variations in the confidence levels of the participants prior to and following the completion of the training course. Accordingly, although the confidence of the students did not increase during the 6 months of in-hospital training, nevertheless, in their final year of study, the ETTC helped to increase the confidence level of medical students.
Reference List
Cameron, P., Cameron, P., & Stoelwinder, J. (2007). Quality indicators in trauma: Using data to monitor the quality of care. Web.
Lin, H., Chen, C., Lee, W., Kuo, L., Cheng, Y., Lin, Y., Lin, J., & Chan, H. (2009). Effects of the Emergency Trauma Training Course on the Confidence of Final-Year Medical Students Dealing with Trauma Patients. The Kaohsiung Journal of Medical Sciences, 25(1), 10-15
Stelfox, H. T., Artiuch, B. B., Nathens, A.,& Straus, S. E. (2010). Quality Indicators for Evaluating Trauma Care. Arch Surg,145(3), 286-295.
Willis, C. D., Evans, S. M., Stoelwinder, J. U., & Cameron, P. A. (2007). Measuring quality. Aust Health Rev, 31(2), 276-81
Willis, C. D., Gabbe, B. J., & Cameron, P. A. (2007). Measuring quality in trauma care. Injury, 38(5), 527-37.
Willis, C. D., Stoelwinder, J. U., & Cameron, P. A. (2008). Interpreting process indicators in trauma care: construct validity versus confounding by indication. Int J Qual Health Care, 20(5),331-8.
Wisborg, T., Brattebø, G., Brinchmann-Hansen, Å., Per Einar, U., & Schrøder, H. (2008). Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals. Journal of Trauma-Injury Infection & Critical Care, 64(6), 1613-1618