title: Access to a Canadian provincial integrated trauma system: a population-based cohort study.
abstract: BACKGROUND
  Access to specialised trauma care is an important measure of trauma system efficiency. However, few data are available on access to integrated trauma systems. We aimed to describe access to trauma centres (TCs) in an integrated Canadian trauma system and identify its determinants.
  
  
  METHODS
  We conducted a population-based cohort study including all injured adults admitted to acute care hospitals in the province of Québec between 2006 and 2011. Proportions of injured patients transported directly or transferred to TCs were assessed. Determinants of access were identified through a modified Poisson regression model and a relative importance analysis was used to determine the contribution of each independent variable to predicting access.
  
  
  RESULTS
  Of the 135,653 injury admissions selected, 75% were treated within the trauma system. Among 25,522 patients with major injuries [International Classification of diseases Injury Severity Score (ICISS<0.85)], 90% had access to TCs. Access was higher for patients aged under 65, men and among patients living in more remote areas (p-value <0.001). The region of residence followed by injury mechanism, number of trauma diagnoses, injury severity and age were the most important determinants of access to trauma care.
  
  
  CONCLUSIONS
  In an integrated, mature trauma system, we observed high access to TCs. However, problems in access were observed for the elderly, women and in urban areas where there are many non-designated hospitals. Access to trauma care should be monitored as part of quality of care improvement activities and pre-hospital guidelines for trauma patients should be applied uniformly throughout the province.
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, Québec, QC, Canada. Electronic address: brice-lionel.batomen-kuimi.1@ulaval.ca.
authors: Brice L Batomen
authors: BL
authors: Kuimi
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: Lynne
authors: L
authors: Moore
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: Brahim
authors: B
authors: Cissé
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada; Institut National de Santé Publique du Québec, Québec, QC, Canada.
authors: Mathieu
authors: M
authors: Gagné
authors: Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Traumatologie-Urgence-Soins intensifs), Centre de Recherche du CHU de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada.
authors: André
authors: A
authors: Lavoie
authors: Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada.
authors: Gilles
authors: G
authors: Bourgeois
authors: Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada.
authors: Jean
authors: J
authors: Lapointe
authors: Institut National de Santé Publique du Québec, Québec, QC, Canada; Department of Medicine, Université Laval, Québec, QC, Canada; Department of medicine, Sherbrooke University, Québec, QC, Canada.
authors: Sonia
authors: S
authors: Jean
mesh_terms: D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D015601:Injury Severity Score; D009104:Multiple Trauma; D017063:Outcome Assessment, Health Care; D011792:Quebec / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*
keywords: Access to care; Injury; Trauma system