title: Influence of trauma system implementation on process of care delivered to seriously injured patients in rural trauma centers.
abstract: BACKGROUND
  Statewide trauma systems are implemented by health care policy makers whose intent is to improve the process of care delivered to seriously injured patients. In Oregon, Advanced Trauma Life Support (ATLS) training was mandated for all physicians employed in the emergency department of trauma centers. The purpose of this study was to test the hypothesis that mandatory ATLS training favorably influenced processes of care.
  
  
  METHODS
  Seriously injured patients treated at 9 rural Level 3 and Level 4 hospitals were studied before (PRE) and after (POST) implementation of Oregon's trauma system. The processes of care evaluated on the basis of chart review were 20 diagnostic and therapeutic interventions advocated in the ATLS course. A cumulative process score (CPS) between 0 and 1 was assigned on the basis of the processes of care delivered. A CPS of 1 indicated optimal process of care.
  
  
  RESULTS
  Mean CPS for 506 PRE period patients (0.44 +/- 0.27) was significantly lower than the mean CPS for 512 POST period patients (0.57 +/- 0.27) with an unpaired t test (P <.001). For the subgroup with injury severity score of 16 to 34, the mean CPS of survivors (0.67 +/- 0.19) was significantly higher than the mean CPS of decedents (0.57 +/- 0.25).
  
  
  CONCLUSIONS
  Process of care for seriously injured patients improved after categorization of rural trauma centers in Oregon. Evidence shows improved process of care may have benefitted patients with serious but survivable injuries. Measurement of process of care is an alternative to mortality analysis as an indication of the quality of care.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, School of Medicine, Portland, OR 97201, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Olson
authors.forename: M
authors.initials: M
authors.lastname: Arthur
authors.forename: R J
authors.initials: RJ
authors.lastname: Mullins
authors.forename: D
authors.initials: D
authors.lastname: Rowland
authors.forename: J R
authors.initials: JR
authors.lastname: Hedges
authors.forename: N C
authors.initials: NC
authors.lastname: Mann
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004638:Emergency Treatment / Q000145:classification / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000145:classification / Q000592:standards*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D009922:Oregon / Q000453:epidemiology; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013221:State Health Plans; D017749:Total Quality Management; D014193:Trauma Centers / Q000145:classification / Q000592:standards* / Q000706:statistics & numerical data; D014194:Traumatology / Q000193:education*; D014481:United States; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy