title: Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study.
abstract: BACKGROUND
  Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries.
  
  
  OBJECTIVE
  To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods.
  
  
  METHODS
  We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider.
  
  
  RESULTS
  We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial "golden" hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).
  
  
  CONCLUSIONS
  Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Centro de Trastornos Respiratorios del Sueño (CENTRES), Clínica Anglo Americana, Lima, Peru ; Grupo de Investigación en Sueño (GIS), Lima, Peru ; Hospital Clínic de Barcelona, Barcelona, 08036, Spain.
authors.forename: Edmundo
authors.initials: E
authors.lastname: Rosales-Mayor
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle WA, 98195-7236, USA ; Harborview Injury Prevention & Research Center (HIPRC), University of Washington, Seattle WA, 98104-2499, USA.
authors.forename: D Alex
authors.initials: DA
authors.lastname: Quistberg
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru.
authors.forename: Ada
authors.initials: A
authors.lastname: Paca-Palao
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru.
authors.forename: Camila
authors.initials: C
authors.lastname: Gianella
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Dirección de Formación Profesional y los Recursos Humanos, Ministerio del Trabajo y Promoción del Empleo, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Lopez
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Departamento de Ciencias Sociales y Políticas, Universidad del Pacífico, Lima, Peru ; Asociación Civil, Gobierno Coherente, Lima, Peru.
authors.forename: Diego
authors.initials: D
authors.lastname: Luna
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Pablo
authors.initials: P
authors.lastname: Best
authors.affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru ; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Huicho