title: Evaluation of Quality of Trauma Care in a Local Hospital Using a Customization of ASCOT.
abstract: OBJECTIVE
  Evaluating processes of care and outcomes of injured patients are important if improvements in the quality of care delivered to injured patients are to be accomplished. We applied a customized ASCOT model developed from our database as a tool to criticize the quality of care in a local hospital.
  
  
  METHODS
  A total number of 4,096 trauma patients were used to develop new coefficients for customization of ASCOT. These patients were divided randomly into two equal groups. New coefficients for ASCOT were derived from the first set of patients. The newly developed model was validated in the second group of patients and the measures of discrimination (area under the ROC curve) and calibration (Hosmer-Lemeshow goodness of fit) were calculated. Then we used the customized model to calculate the W score in different subgroups of patients treated in a local hospital to evaluate the care offered to patients in each group.
  
  
  RESULTS
  The customized ASCOT had a good discrimination (area under ROC curve = 0.9575) and calibration (Hosmer-Lemeshow goodness of fit p value = 0.7628) in the validation dataset. Using the customized model, we calculated W score in different subgroup of patients treated in a local hospital for a period of six months. The quality of care was worst for laparotomy (W = -13.31) and pelvic fracture (W = -5.56) and best for orthopedic (W = 1.76) operations.
  
  
  CONCLUSIONS
  We believe that a customization of ASCOT model when used for evaluation of quality of care in a local hospital can be useful for detection of defects and improvement of the process of care delivered to the patients.
authors.affiliation: Department of Surgery, Sina Hospital Medical Sciences/Tehran University, Hassan-abad Square, 1136933511, Tehran, Iran. moinim@hotmail.com.
authors.forename: Majid
authors.initials: M
authors.lastname: Moini
authors.forename: Hamed
authors.initials: H
authors.lastname: Rezaishiraz
authors.forename: Alireza
authors.initials: A
authors.lastname: Zarineh
authors.affiliation: Department of Surgery, Sina Hospital, Medical Sciences/Tehran University, Tehran, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
keywords: Emergency medical service; Hospital; Injury Severity Score; Models; Quality of health care; Trauma
references.citation: J Trauma. 1996 Jan;40(1):42-8; discussion 48-9
references.pmid: 8576997
references.citation: Injury. 1992;23(8):511-4
references.pmid: 1286899
references.citation: Crit Care Med. 1980 Apr;8(4):201-8
references.pmid: 7357873
references.citation: J Trauma. 1987 Apr;27(4):370-8
references.pmid: 3106646
references.citation: J Trauma. 1976 Jul;16(7):517-23
references.pmid: 948092
references.citation: J Trauma. 2000 Mar;48(3):503-7
references.pmid: 10744293
references.citation: J Trauma. 1991 Apr;31(4):471-81; discussion 481-2
references.pmid: 2020032
references.citation: Kaohsiung J Med Sci. 1996 Dec;12(12):691-8
references.pmid: 9011127
references.citation: JAMA. 1985 Aug 23-30;254(8):1059-63
references.pmid: 3894708
references.citation: Injury. 1989 Jan;20(1):10-2
references.pmid: 2592056
references.citation: J Trauma. 1990 May;30(5):539-45; discussion 545-6
references.pmid: 2342136