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Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study

BACKGROUND: Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to tra...

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Autores principales: Dworkin, M., Agarwal-Harding, K. J., Joseph, M., Cahill, G., Konadu-Yeboah, D., Makasa, E., Mock, C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470913/
https://www.ncbi.nlm.nih.gov/pubmed/37651448
http://dx.doi.org/10.1371/journal.pone.0290816
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author Dworkin, M.
Agarwal-Harding, K. J.
Joseph, M.
Cahill, G.
Konadu-Yeboah, D.
Makasa, E.
Mock, C.
author_facet Dworkin, M.
Agarwal-Harding, K. J.
Joseph, M.
Cahill, G.
Konadu-Yeboah, D.
Makasa, E.
Mock, C.
author_sort Dworkin, M.
collection PubMed
description BACKGROUND: Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. STUDY OBJECTIVES: The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. METHODS: A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. RESULTS: The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. CONCLUSIONS: The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care.
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spelling pubmed-104709132023-09-01 Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study Dworkin, M. Agarwal-Harding, K. J. Joseph, M. Cahill, G. Konadu-Yeboah, D. Makasa, E. Mock, C. PLoS One Research Article BACKGROUND: Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. STUDY OBJECTIVES: The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. METHODS: A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. RESULTS: The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. CONCLUSIONS: The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care. Public Library of Science 2023-08-31 /pmc/articles/PMC10470913/ /pubmed/37651448 http://dx.doi.org/10.1371/journal.pone.0290816 Text en © 2023 Dworkin et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dworkin, M.
Agarwal-Harding, K. J.
Joseph, M.
Cahill, G.
Konadu-Yeboah, D.
Makasa, E.
Mock, C.
Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title_full Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title_fullStr Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title_full_unstemmed Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title_short Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study
title_sort indicators for the evaluation of musculoskeletal trauma systems: a scoping review and delphi study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470913/
https://www.ncbi.nlm.nih.gov/pubmed/37651448
http://dx.doi.org/10.1371/journal.pone.0290816
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