Evaluating Quality in Trauma Systems

Trauma remains a major global threat to health and is almost unique in the extent to which patient outcomes depend upon time-sensitive integration of prehospital and critical care services, as well as comprehensive inpatient care and rehabilitation. Evaluating the quality of trauma care is complex, because within such a “system of systems,” performance cannot be predicted solely through analysis of individual clinical services. Institution-level indices necessarily provide an incomplete picture of quality, as outcomes are affected not only by patients’ injuries and comorbidities but also by incident location and time to definitive care. In this chapter, we outline one approach to holistic evaluation of trauma system quality. We demonstrate how familiar measures of quality such as standardized mortality ratios can be applied in conjunction with spatial analysis techniques in order to produce geographically indexed outcome data with respect to patient, environmental, and social risk factors. We also outline how spatial analysis can be augmented by linkage to repositories of routinely collected administrative data. Though a relatively new approach to quality assurance and improvement, data-linkage-facilitated spatial analysis is particularly relevant to trauma, and we predict that it will become a core component of trauma quality evaluation in developed health systems. We encourage all clinicians to move beyond their direct responsibilities for patient care and engage with quality evaluation at the system level so that we may continue to approach the trauma system ideal of providing care to the right patient, at the right place, at the right time