title: Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.
abstract: Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited.
  
  
  
  This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru.
  
  
  
  Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices.
  
  
  
  A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Campus Box #356410, Seattle, WA, 98104, USA. lagronel@uw.edu.
authors.forename: Lacey N
authors.initials: LN
authors.lastname: LaGrone
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Fuhs
authors.affiliation: Hospital Nacional Guillermo Almenara, Lima, Peru.
authors.forename: Eduardo Huaman
authors.initials: EH
authors.lastname: Egoavil
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Manuel J A
authors.initials: MJ
authors.lastname: Rodriguez Castro
authors.affiliation: Hospital Nacional Guillermo Almenara, Lima, Peru.
authors.forename: Roberto
authors.initials: R
authors.lastname: Valderrama
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Campus Box #356410, Seattle, WA, 98104, USA.
authors.forename: Leah N
authors.initials: LN
authors.lastname: Isquith-Dicker
authors.affiliation: Hospital de Policía, Lima, Peru.
authors.forename: Jaime
authors.initials: J
authors.lastname: Herrera-Matta
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Campus Box #356410, Seattle, WA, 98104, USA.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Mock
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D010568:Peru; D017064:Process Assessment, Health Care / Q000592:standards*; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000628:therapy*