Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata

Effect on Care Process Measures

Angela Lashoher, Eric B. Schneider, Catherine Juillard, Kent A Stevens, Elizabeth Ann Colantuoni, William R. Berry, Christina Bloem, Witaya Chadbunchachai, Satish Dharap, Sydney E Dy, Gerald Dziekan, Russell L. Gruen, Jaymie A. Henry, Christina Huwer, Manjul Joshipura, Edward Kelley, Etienne Krug, Vineet Kumar, Patrick Kyamanywa, Alain Chichom Mefire & 13 others Marcos Musafir, Avery B. Nathens, Edouard Ngendahayo, Thai Son Nguyen, Nobhojit Roy, Peter J. Pronovost, Irum Qumar Khan, Junaid Razzak, Andrés M. Rubiano, James A. Turner, Mathew Varghese, Rimma Zakirova, Charles Mock

Research output: Contribution to journalArticle

Abstract

Background: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. Methods: From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Results: Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses. Conclusions: Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Oct 31 2016

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Process Assessment (Health Care)
Checklist
Economics
Wounds and Injuries
Patient Care
Logistic Models
Auscultation
Injury Severity Score
Resuscitation
Thorax
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata : Effect on Care Process Measures. / Lashoher, Angela; Schneider, Eric B.; Juillard, Catherine; Stevens, Kent A; Colantuoni, Elizabeth Ann; Berry, William R.; Bloem, Christina; Chadbunchachai, Witaya; Dharap, Satish; Dy, Sydney E; Dziekan, Gerald; Gruen, Russell L.; Henry, Jaymie A.; Huwer, Christina; Joshipura, Manjul; Kelley, Edward; Krug, Etienne; Kumar, Vineet; Kyamanywa, Patrick; Mefire, Alain Chichom; Musafir, Marcos; Nathens, Avery B.; Ngendahayo, Edouard; Nguyen, Thai Son; Roy, Nobhojit; Pronovost, Peter J.; Khan, Irum Qumar; Razzak, Junaid; Rubiano, Andrés M.; Turner, James A.; Varghese, Mathew; Zakirova, Rimma; Mock, Charles.

In: World Journal of Surgery, 31.10.2016, p. 1-9.

Research output: Contribution to journalArticle

Lashoher, A, Schneider, EB, Juillard, C, Stevens, KA, Colantuoni, EA, Berry, WR, Bloem, C, Chadbunchachai, W, Dharap, S, Dy, SE, Dziekan, G, Gruen, RL, Henry, JA, Huwer, C, Joshipura, M, Kelley, E, Krug, E, Kumar, V, Kyamanywa, P, Mefire, AC, Musafir, M, Nathens, AB, Ngendahayo, E, Nguyen, TS, Roy, N, Pronovost, PJ, Khan, IQ, Razzak, J, Rubiano, AM, Turner, JA, Varghese, M, Zakirova, R & Mock, C 2016, 'Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures', World Journal of Surgery, pp. 1-9. https://doi.org/10.1007/s00268-016-3759-8
Lashoher, Angela ; Schneider, Eric B. ; Juillard, Catherine ; Stevens, Kent A ; Colantuoni, Elizabeth Ann ; Berry, William R. ; Bloem, Christina ; Chadbunchachai, Witaya ; Dharap, Satish ; Dy, Sydney E ; Dziekan, Gerald ; Gruen, Russell L. ; Henry, Jaymie A. ; Huwer, Christina ; Joshipura, Manjul ; Kelley, Edward ; Krug, Etienne ; Kumar, Vineet ; Kyamanywa, Patrick ; Mefire, Alain Chichom ; Musafir, Marcos ; Nathens, Avery B. ; Ngendahayo, Edouard ; Nguyen, Thai Son ; Roy, Nobhojit ; Pronovost, Peter J. ; Khan, Irum Qumar ; Razzak, Junaid ; Rubiano, Andrés M. ; Turner, James A. ; Varghese, Mathew ; Zakirova, Rimma ; Mock, Charles. / Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata : Effect on Care Process Measures. In: World Journal of Surgery. 2016 ; pp. 1-9.
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abstract = "Background: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. Methods: From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Results: Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 {\%} female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 {\%}) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses. Conclusions: Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.",
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T1 - Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata

T2 - Effect on Care Process Measures

AU - Lashoher, Angela

AU - Schneider, Eric B.

AU - Juillard, Catherine

AU - Stevens, Kent A

AU - Colantuoni, Elizabeth Ann

AU - Berry, William R.

AU - Bloem, Christina

AU - Chadbunchachai, Witaya

AU - Dharap, Satish

AU - Dy, Sydney E

AU - Dziekan, Gerald

AU - Gruen, Russell L.

AU - Henry, Jaymie A.

AU - Huwer, Christina

AU - Joshipura, Manjul

AU - Kelley, Edward

AU - Krug, Etienne

AU - Kumar, Vineet

AU - Kyamanywa, Patrick

AU - Mefire, Alain Chichom

AU - Musafir, Marcos

AU - Nathens, Avery B.

AU - Ngendahayo, Edouard

AU - Nguyen, Thai Son

AU - Roy, Nobhojit

AU - Pronovost, Peter J.

AU - Khan, Irum Qumar

AU - Razzak, Junaid

AU - Rubiano, Andrés M.

AU - Turner, James A.

AU - Varghese, Mathew

AU - Zakirova, Rimma

AU - Mock, Charles

PY - 2016/10/31

Y1 - 2016/10/31

N2 - Background: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. Methods: From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Results: Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses. Conclusions: Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.

AB - Background: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. Methods: From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Results: Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses. Conclusions: Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.

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