title: Trauma center quality improvement programs in the United States, Canada, and Australasia.
abstract: OBJECTIVE
  To compare quality improvement (QI) programs of trauma centers in 4 high-income countries.
  
  
  BACKGROUND
  Injury is a leading cause of morbidity and mortality in countries around the world, but patient outcomes vary among countries with similar systems of trauma care.
  
  
  METHODS
  We surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), and Australasia (Australia, n = 18; New Zealand, n = 3) regarding their QI programs. Quality indicators were requested from all centers that measured quality of care. Follow-up interviews were performed with 75 centers purposively sampled across 6 baseline criteria.
  
  
  RESULTS
  A total of 251 centers (76% response rate) responded to the survey, with a similar distribution across countries. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators (100% vs 94% vs 93%, P = 0.008), using report cards (53% vs 33% vs 31%, P = 0.033) and benchmarking (81% vs 61% vs 69%, P = 0.019). Centers in all 3 regions primarily used hospital process and outcome measures designed to establish whether care was safe (98% vs 97% vs 75%, P = 0.008), effective (97% vs 97% vs 92% P = 0.399), timely (88% vs 100% vs 92%, P = 0.055), and efficient (95% vs 100% vs 83%, P = 0.082). QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program.
  
  
  CONCLUSIONS
  This study provides the first international comparison of trauma center QI programs and demonstrates broad implementation in verified trauma centers in the United States, Canada, and Australasia. Significant variation exists in how trauma centers perform QI activities. Opportunities exist for improving and standardizing QI processes.
authors.affiliation: Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Canada. tstelfox@ucalgary.ca
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
authors.forename: Syed M
authors.initials: SM
authors.lastname: Hameed
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirkpatrick
mesh_terms: D044362:Australasia; D002170:Canada; D019538:Health Care Surveys; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D014193:Trauma Centers / Q000592:standards*; D014481:United States