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Zheng DJ, Mbuh LN, Oke R, Tanjong SMM, Carvalho M, Herman BL, Guidam D, Mbengawoh NZ, Nlong Mang R, Dissak-Delon FN, Christie SA, Chichom-Mefire A, Juillard C. Preventability of injury-related morbidity & mortality at four hospitals in Cameroon: A systematic approach to trauma quality improvement. World J Surg 2024. [PMID: 39095973 DOI: 10.1002/wjs.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Adverse events reviews are a fundamental component of trauma quality improvement (QI) that facilitate the correction of systemic issues in care. Although injury-related mortality in Cameroon is substantial, to our knowledge, opportunities for QI have not been formally assessed. Thus, a formal review of adverse events in Cameroonian trauma patients was implemented as a first step toward identifying targets for systems modification. METHODS A QI committee composed of multidisciplinary experts at four hospitals in Cameroon was formed to review adverse events including deaths among trauma patients from 2019 to 2021. Events were discussed at newly established morbidity and mortality conferences and committee meetings to identify contributing factors and overall preventability. RESULTS During 50 meetings, 95 adverse events were reviewed, including 58 deaths (61%). Other adverse events were delays in diagnosis/treatment (22%) and surgical site infections (17%). Overall, 34 deaths (59%) were classified as preventable, 21% potentially preventable, and 21% not preventable. Over half (52%) of the 46 preventable or potentially preventable deaths occurred in the emergency department (ED); while brain injury (57%), respiratory failure (41%), and hemorrhage (39%) were the most frequent physiologic factors associated with mortality. Contributory factors identified include lack of a structured approach to patient management, absence of continuous training for personnel, and locally adapted protocols. CONCLUSIONS Basic improvements in evaluation and management of life-threatening issues in the ED can significantly reduce the high rate of preventable trauma-related deaths across Cameroon. Formal trauma QI methods can be utilized in low-resource environments to determine mortality root causes and identify intervention targets.
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Affiliation(s)
- Dennis J Zheng
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Rasheedat Oke
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Melissa Carvalho
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Débora Guidam
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - René Nlong Mang
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - S Ariane Christie
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Catherine Juillard
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Alao DO, Cevik AA, Al Shamsi F, Mousa H, Elnikety S, Benour M, Al-Bluwi GSM, Abu-Zidan FM. Preventable deaths in hospitalized trauma patients. World J Surg 2024; 48:863-870. [PMID: 38381056 DOI: 10.1002/wjs.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
AIM To study the preventable trauma deaths of hospitalized patients in the United Arab Emirates and to identify opportunities for improvement. METHODS We analyzed the Abu Dhabi Emirate Trauma Registry data of admitted patients who died in the emergency department or in hospital from 2014 to 2019. A panel of experts categorize the deaths into not preventable (NP), potentially preventable (PP), and definitely preventable (DP). RESULTS A total of 405 deaths were included, and 82.7% were males. The majority (89.1%) were NP, occurring mainly in the emergency department (40.4%) and the intensive care unit (49.9%). The combined potentially preventable and preventable death rate was 10.9%. The median (Interquartile range) age of the DP was 57.5 (37-76) years, compared with 32 (24-42) and 34 (25-55) years for NP and PP, respectively (p = 0.008). Most of the PP deaths occurred in the intensive care unit (55.6%), while the DP occurred mainly in the ward (50%). Falls accounted for 25% of PP and DP. Deficiencies in airway care, hemorrhage control, and fluid management were identified in 25%, 43.2% and 29.5% of the DP/PP deaths, respectively. Seventy-two percent of the Airway deficiencies occurred in the prehospital, while 34.1% of hemorrhage control deficiencies were in the emergency department. Fluid management deficiencies occurred in the emergency department and the operation theater. CONCLUSIONS DP and PP deaths comprised 10.9% of the deaths. Most of the DP occurred in the emergency department and ward. Prehospital Airway and in-hospital hemorrhage and excessive fluid were the main areas for opportunities for improvement.
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Affiliation(s)
- David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Emergency Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Emergency Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Fayez Al Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Critical Care Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hussam Mousa
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Surgery Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Sherif Elnikety
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Surgery Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Mahmoud Benour
- Neurosurgery Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Ghada S M Al-Bluwi
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Mesic A, Gyedu A, Mehta K, Goodman SK, Mock C, Quansah R, Donkor P, Stewart B. Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers. World J Surg 2022; 46:2607-2615. [PMID: 35994075 PMCID: PMC10424506 DOI: 10.1007/s00268-022-06686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Ghana has a large and growing burden of injury morbidity and mortality. There is a substantial unmet need for trauma surgery, highlighting a need to understand gaps in care. METHODS We conducted 8 in-depth interviews with trauma care providers (surgeons, nurses, and specialists) at a large teaching hospital to understand factors that contribute to and reduce delays in the provision of adequate trauma care for severely injured patients. The study aimed to understand whether providers thought factors differed between patients that were enrolled in the National Health Insurance Scheme (NHIS) and those that were not. Findings were presented for the third delay (provision of appropriate care) in the Three Delays Framework. RESULTS Key findings included that most factors contributing delays in the provision of adequate care were related to the costs of care, including for diagnostics, medications, and treatment for patients with and without NHIS subscription. Other notable factors included conflicts between providers, resource constraints, and poor coordination of care at the facility. Factors which reduce delays included advocacy by providers and informal processes for prioritizing critical injuries. CONCLUSION We recommend facility-level changes including increasing equity in access to trauma and elective surgery through targeted system strengthening efforts (e.g., a scheduled back-up call system for surgeons, anesthetists, other specialists, and nurses; designated operating theatres and staff for emergencies; training of staff), policy changes to simplify the insurance renewal and subscription processes, and future research on the costs and benefits of including diagnostics, medications, and common trauma services into the NHIS benefits package.
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Affiliation(s)
- Aldina Mesic
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Robert Quansah
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Hakkenbrak NAG, Mikdad SY, Zuidema WP, Halm JA, Schoonmade LJ, Reijnders UJL, Bloemers FW, Giannakopoulos GF. Preventable death in trauma: A systematic review on definition and classification. Injury 2021; 52:2768-2777. [PMID: 34389167 DOI: 10.1016/j.injury.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Trauma-related preventable death (TRPD) has been used to assess the management and quality of trauma care worldwide. However, due to differences in terminology and application, the definition of TRPD lacks validity. The aim of this systematic review is to present an overview of current literature and establish a designated definition of TRPD to improve the assessment of quality of trauma care. METHODS A search was conducted in PubMed, Embase, the Cochrane Library and the Web of Science Core Collection. Including studies regarding TRPD, published between January 1, 1990, and April 6, 2021. Studies were assessed on the use of a definition of TRPD, injury severity scoring tool and panel review. RESULTS In total, 3,614 articles were identified, 68 were selected for analysis. The definition of TRPD was divided in four categories: I. Clinical definition based on panel review or expert opinion (TRPD, trauma-related potentially preventable death, trauma-related non-preventable death), II. An algorithm (injury severity score (ISS), trauma and injury severity score (TRISS), probability of survival (Ps)), III. Clinical definition completed with an algorithm, IV. Other. Almost 85% of the articles used a clinical definition in some extend; solely clinical up to an additional algorithm. A total of 27 studies used injury severity scoring tools of which the ISS and TRISS were the most frequently reported algorithms. Over 77% of the panels included trauma surgeons, 90% included other specialist; 61% emergency medicine physicians, 46% forensic pathologists and 43% nurses. CONCLUSION The definition of TRPD is not unambiguous in literature and should be based on a clinical definition completed with a trauma prediction algorithm such as the TRISS. TRPD panels should include a trauma surgeon, anesthesiologist, emergency physician, neurologist, and forensic pathologist.
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Affiliation(s)
- N A G Hakkenbrak
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands.
| | - S Y Mikdad
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - W P Zuidema
- Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - U J L Reijnders
- Department of Forensic Medicine, Public Health Service of Amsterdam, the Netherlands
| | - F W Bloemers
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - G F Giannakopoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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Gyedu A, Goodman SK, Quansah R, Osei-Ampofo M, Donkor P, Mock C. Assessing the appropriateness of blood transfusion among injured patients at a Ghanaian tertiary hospital: Time for clarity on the use of a scarce resource. Injury 2021; 52:1164-1169. [PMID: 33558023 PMCID: PMC8107114 DOI: 10.1016/j.injury.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/31/2020] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemorrhage is an important cause of preventable injury-related death. Many low- and middle-income country (LMIC) patients do not have timely access to safe blood. We sought to determine the degree of appropriateness of blood transfusion among patients with injuries requiring surgical intervention at presentation to a tertiary hospital in Ghana. METHODS We performed a retrospective review of such patients presenting to Komfo Anokye Teaching Hospital (KATH), from January 2015 to December 2016. Patients' hemoglobin levels at presentation were determined as the first record of hemoglobin after presentation and their receipt of blood transfusion was determined by explicit documentation in the chart. We defined appropriate blood transfusion practice as patients receiving transfusion when hemoglobin was equal or below a threshold, or patients not being transfused when hemoglobin was above the threshold. We considered both restrictive (hemoglobin ≤7 g/dL) and liberal (hemoglobin ≤10 g/dL) transfusion thresholds. RESULTS There were 1,408 patients who presented to KATH with injuries that met inclusion criteria. Two hundred and ninety two (292) patients were excluded because of missing hemoglobin information. Four hundred and fifty eight (458;41%) patients received blood transfusion. Transfused patients had a higher mean age (38 vs 35 years) and were less likely to be male (62% vs 71%). Transfused patients underwent more external fixation procedures (28% vs 19%), trauma amputations (5% vs 1%) and trauma laparotomies (3% vs 1%). At a restrictive transfusion threshold (hemoglobin ≤7 g/dL), 20% of patients who needed a transfusion did not receive one and 39% of patients who did not need a transfusion received one. At a liberal threshold (hemoglobin ≤10 g/dL), 33% of patients who needed a transfusion did not receive one and 30% of patients who did not need a transfusion received one. Blood transfusion practice was inappropriate in 31%-39% of all patients. CONCLUSION Our data suggest that clearer guidelines for blood transfusion among emergency surgery patients are needed in Ghana and similar LMICs to avoid inappropriate use of blood as a scarce resource.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - Robert Quansah
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Maxwell Osei-Ampofo
- Department of Medicine; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Peter Donkor
- Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA, Global Injury Control Section, Harborview Injury Prevention and Research Center.
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Stewart BT, Gyedu A, Goodman SK, Boakye G, Scott JW, Donkor P, Mock C. Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children. Afr J Emerg Med 2021; 11:144-151. [PMID: 33680736 PMCID: PMC7910164 DOI: 10.1016/j.afjem.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Ghana implemented a National Health Insurance Scheme (NHIS) in 2003 as a step toward universal health coverage. We aimed to determine the effect of the NHIS on timeliness of care, mortality, and catastrophic health expenditure (CHE) among children with serious injuries at a trauma center in Ghana. Methods We performed a retrospective cohort study of injured children aged <18 years who required surgery (i.e., proxy for serious injury) at Komfo Anokye Teaching Hospital from 2015 to 2016. Household income data was obtained from the Ghana Statistical Service. CHE was defined as out-of-pocket payments to annual household income ≥10%. Differences in insured and uninsured children were described. Multivariable regression was used to assess the effect of NHIS on time to surgery, length of stay, in-hospital mortality, out-of-pocket expenditure and CHE. Results Of the 263 children who met inclusion criteria, 70% were insured. Mechanism of injury, triage scores and Kampala Trauma Score II were similar in both groups (all p > 0.10). Uninsured children were more likely to have a delay in care for financial reasons (17.3 vs 6.4%, p < 0.001) than insured children, and the families of uninsured children paid a median of 1.7 times more out-of-pocket costs than families with insured children (p < 0.001). Eighty-six percent of families of uninsured children experienced CHE compared to 54% of families of insured children (p < 0.001); however, 64% of all families experienced CHE. Insurance was protective against CHE (aOR 0.21, 95%CI 0.08–0.55). Conclusions NHIS did not improve timeliness of care, length of stay or mortality. Although NHIS did provide some financial risk protection for families, it did not eliminate out-of-pocket payments. The families of most seriously injured children experienced CHE, regardless of insurance status. NHIS and similar financial risk pooling schemes could be strengthened to better provide financial risk protection and promote quality of care for injured children. Despite strides toward universal health coverage with the National Health Insurance Scheme (NHIS) in Ghana, one third of injured children did not have insurance. Families on uninsured injured children pay markedly more out-of-pocket costs than families of insured children. Although families of uninsured children were more likely to experience catastrophic health expenditure (CHE), CHE was commonly experienced regardless of insurance. These findings have useful implications for NHIS, agencies working toward universal health coverage, and trauma systems generally.
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Konadu-Yeboah D, Kwasi K, Donkor P, Gudugbe S, Sampen O, Okleme A, Boakye FN, Osei-Ampofo M, Okrah H, Mock C. Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. World J Surg 2020; 44:3643-3650. [PMID: 32661695 PMCID: PMC7529993 DOI: 10.1007/s00268-020-05683-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the rate of preventable trauma deaths in an African hospital, identify the potential effect of improvements in trauma care over the past decade and identify deficiencies in care that still need to be addressed. METHODS A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive in-hospital trauma deaths over 5 months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care. RESULTS Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison with a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p = 0.07) There was a notable change in the pattern of deficiency (p = 0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17 to 8%), but an increase in delay in treatment at the hospital (23 to 40%). CONCLUSIONS Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.
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Affiliation(s)
- Dominic Konadu-Yeboah
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kusi Kwasi
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Senyo Gudugbe
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ossei Sampen
- Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Augustus Okleme
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Maxwell Osei-Ampofo
- Directorate of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Helena Okrah
- Department of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
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Gyedu A, Goodman SK, Katz M, Quansah R, Stewart BT, Donkor P, Mock C. National health insurance and surgical care for injured people, Ghana. Bull World Health Organ 2020; 98:869-877. [PMID: 33293747 PMCID: PMC7716100 DOI: 10.2471/blt.20.255315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the association between having government health insurance and the timeliness and outcome of care, and catastrophic health expenditure in injured patients requiring surgery at a tertiary hospital in Ghana. Methods We reviewed the medical records of injured patients who required surgery at Komfo Anokye Teaching Hospital in 2015-2016 and extracted data on sociodemographic and injury characteristics, outcomes and out-of-pocket payments. We defined catastrophic health expenditure as ≥ 10% of the ratio of patients' out-of-pocket payments to household annual income. We used multivariable regression analyses to assess the association between having insurance through the national health insurance scheme compared with no insurance and time to surgery, in-hospital mortality and experience of catastrophic health expenditure, adjusted for potentially confounding variables. Findings Of 1396 patients included in our study, 834 (60%) were insured through the national health insurance scheme. Time to surgery and mortality were not statistically different between insured and uninsured patients. Insured patients made smaller median out-of-pocket payments (309 United States dollars, US$) than uninsured patients (US$ 503; P < 0.001). Overall, 45% (443/993) of patients faced catastrophic health expenditure. A smaller proportion of insured patients (33%, 184/558) experienced catastrophic health expenditure than uninsured patients (60%, 259/435; P < 0.001). Insurance through the national health insurance scheme reduced the likelihood of catastrophic health expenditure (adjusted odds ratio: 0.27; 95% confidence interval: 0.20 to 0.35). Conclusion The national health insurance scheme needs strengthening to provide better financial risk protection and improve quality of care for patients presenting with injuries that require surgery.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Postal Mail Bag, University Campus, Kumasi, Ghana
| | | | - Micah Katz
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Robert Quansah
- Department of Surgery, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Postal Mail Bag, University Campus, Kumasi, Ghana
| | | | - Peter Donkor
- Department of Surgery, KNUST School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Postal Mail Bag, University Campus, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, USA
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Kouchakinejad-Eramsadati L, Khodadadi-Hassankiadeh N, Rad E, Hajizadeh M, Rezaei S, Heydari H. Explaining gender differences in transfer time to a trauma center in Northern Iran. ARCHIVES OF TRAUMA RESEARCH 2020. [DOI: 10.4103/atr.atr_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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