title: Implementation of a trauma care system: evolution through evaluation.
abstract: BACKGROUND
  The regionalization of trauma services has been implemented in many health care systems and communities over the past 10 to 20 years. As these trauma systems mature and evolve, changes are made to improve the care and efficiency of the system. Trauma care regionalization was introduced in Quebec in 1993. This study looked at the evolution of trauma care in Quebec over the past 13 years, from the preregionalization era to the present.
  
  
  METHODS
  A retrospective review scientifically evaluated a trauma system, the implementation of evidence-based changes, and the efficacy of these changes.
  
  
  RESULTS
  Various changes have been made in the Quebec trauma system since the introduction of regionalization. These changes have led to an incremental decrease in mortality caused by severe trauma from 51.8% in 1992 to 8.6% in 2002.
  
  
  CONCLUSIONS
  A trauma system is fluid and constantly evolving. Research and constant reevaluation are necessary for continuous evaluation of the system and improvement of its outcomes and efficiency.
authors.affiliation: Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: Andre
authors.initials: A
authors.lastname: Lavoie
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
mesh_terms: D004632:Emergency Medical Services; D006801:Humans; D009936:Organizational Innovation; D016730:Program Development; D015397:Program Evaluation; D011792:Quebec / Q000453:epidemiology; D012041:Regional Medical Programs / Q000458:organization & administration* / Q000639:trends; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology; D014218:Triage; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality*