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Gerecht RB, Nable JV. Out-of-Hospital Cardiac Arrest. Cardiol Clin 2024; 42:317-331. [PMID: 38631798 DOI: 10.1016/j.ccl.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.
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Affiliation(s)
- Ryan B Gerecht
- District of Columbia Fire and EMS Department, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Jose V Nable
- Georgetown University School of Medicine, Georgetown EMS, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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2
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Gerecht RB, Nable JV. Out-of-Hospital Cardiac Arrest. Emerg Med Clin North Am 2023; 41:433-453. [PMID: 37391243 DOI: 10.1016/j.emc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.
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Affiliation(s)
- Ryan B Gerecht
- District of Columbia Fire and EMS Department, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Jose V Nable
- Georgetown University School of Medicine, Georgetown EMS, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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Acute Kidney Injury: Iterative Development of an Audit Tool for Trauma Patients. J Trauma Nurs 2023; 30:108-114. [PMID: 36881703 DOI: 10.1097/jtn.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Acute kidney injury is a low-volume, high-risk complication in trauma patients and is associated with prolonged hospital length of stay and increased mortality. Yet, no audit tools exist to evaluate acute kidney injury in trauma patients. OBJECTIVE This study aimed to describe the iterative development of an audit tool to evaluate acute kidney injury following trauma. METHODS Our performance improvement nurses developed an audit tool to evaluate acute kidney injury in trauma patients using an iterative, multiphase process conducted from 2017 to 2021, which included a review of our Trauma Quality Improvement Program data, trauma registry data, literature review, multidisciplinary consensus approach, retrospective and concurrent review, and continuous audit and feedback for piloted and finalized versions of the tool. RESULTS The final acute kidney injury audit tool can be completed within 30 min using data obtained from the electronic medical record and consists of six sections, including identification criteria, source potential causes, source treatment, acute kidney injury treatment, dialysis indications, and outcome status. CONCLUSION The iterative development and testing of an acute kidney injury audit tool improved the uniform data collection, documentation, audit, and feedback of best practices to positively impact patient outcomes.
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Gödde D, Bruckschen F, Burisch C, Weichert V, Nation KJ, Thal SC, Marsch S, Sellmann T. Manual and Mechanical Induced Peri-Resuscitation Injuries-Post-Mortem and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10434. [PMID: 36012068 PMCID: PMC9408363 DOI: 10.3390/ijerph191610434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Injuries related to resuscitation are not usually systematically recorded and documented. By evaluating this data, conclusions could be drawn about the quality of the resuscitation, with the aim of improving patient care and safety. (2) Methods: We are planning to conduct a multicentric, retrospective 3-phased study consisting of (1) a worldwide literature review (scoping review), (2) an analysis of anatomical pathological findings from local institutions in North Rhine-Westphalia, Germany to assess the transferability of the review data to the German healthcare system, and (3) depending on the results, possibly establishing potential prospective indicators for resuscitation-related injuries as part of quality assurance measures. (3) Conclusions: From the comparison of literature and local data, the picture of resuscitation-related injuries will be focused on and quality indicators will be derived.
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Affiliation(s)
- Daniel Gödde
- Department of Pathology and Molecularpathology, Helios University Hospital Wuppertal, University Witten/Herdecke, 58455 Witten, Germany
| | - Florian Bruckschen
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
| | - Christian Burisch
- State of North Rhine-Westphalia/Regional Government, 44145 Düsseldorf, Germany
| | - Veronika Weichert
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Duisburg, 47249 Duisburg, Germany
| | - Kevin J. Nation
- NZRN, New Zealand Resuscitation Council, Wellington 6011, New Zealand
| | - Serge C. Thal
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
- Department of Anesthesiology, HELIOS University Hospital, 42283 Wuppertal, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
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Designing and conducting initial application of a performance assessment model for in-hospital trauma care. BMC Health Serv Res 2022; 22:273. [PMID: 35232439 PMCID: PMC8887084 DOI: 10.1186/s12913-022-07578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures. METHODS This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts' perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center. RESULTS A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts' views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction. CONCLUSION Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.
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Aragon L, Schieman K, Cure L. Incorporating the six aims for quality in the analysis of trauma care. Health Syst (Basingstoke) 2021; 11:98-108. [DOI: 10.1080/20476965.2021.1906763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Lucy Aragon
- Department of Industrial, Systems, and Manufacturing Engineering, Wichita State University, Wichita, United States
- Department of Industrial Engineering, Pontificia Universidad Catolica Del Peru, Lima, Peru
| | - Karen Schieman
- Department of Professional Practice, Western Michigan University/Bronson Hospital, Kalamazoo, United States
| | - Laila Cure
- Department of Industrial, Systems, and Manufacturing Engineering, Wichita State University, Wichita, United States
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Alsenani M, A Alaklobi F, Ford J, Earnest A, Hashem W, Chowdhury S, Alenezi A, Fitzgerald M, Cameron P. Comparison of trauma management between two major trauma services in Riyadh, Kingdom of Saudi Arabia and Melbourne, Australia. BMJ Open 2021; 11:e045902. [PMID: 34006550 PMCID: PMC8137252 DOI: 10.1136/bmjopen-2020-045902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The burden of injury in the Kingdom of Saudi Arabia (KSA) has increased in recent years, but the country has lacked a consistent methodology for collecting injury data. A trauma registry has been established at a large public hospital in Riyadh from which these data are now available. OBJECTIVES We aimed to provide an overview of trauma epidemiology by reviewing the first calendar year of data collection for the registry. Risk-adjusted analyses were performed to benchmark outcomes with a large Australian major trauma service in Melbourne. The findings are the first to report the trauma profile from a centre in the KSA and compare outcomes with an international level I trauma centre. METHODS This was an observational study using records with injury dates in 2018 from the registries at both hospitals. Demographics, processes and outcomes were extracted, as were baseline characteristics. Risk-adjusted endpoints were inpatient mortality and length of stay. Binary logistic regression was used to measure the association between site and inpatient mortality. RESULTS A total of 2436 and 4069 records were registered on the Riyadh and Melbourne databases, respectively. There were proportionally more men in the Saudi cohort than the Australian cohort (86% to 69%). The Saudi cohort was younger, the median age being 36 years compared with 50 years, with 51% of injuries caused by road traffic incidents. The risk-adjusted length of stay was 4.4 days less at the Melbourne hospital (95% CI 3.95 days to 4.86 days, p<0.001). The odds of in-hospital death were also less (OR 0.25; 95% CI 0.15 to 0.43, p<0.001). CONCLUSIONS This is the first hospital-based study of trauma in the kingdom that benchmarks with an individual international centre. There are limitations to interpreting the comparisons, however the findings have established a baseline for measuring continuous improvement in outcomes for KSA trauma services.
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Affiliation(s)
| | | | - Jane Ford
- Alfred Health Trauma Registry, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Waleed Hashem
- Centre of Excellence, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed Alenezi
- Executive Office, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mark Fitzgerald
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Engels PT, Coates A, MacDonald RD, Ahghari M, Welsford M, Dodd T, Turcotte K, Doyle JD, Eugenio AM, Green JP, Irvine JE, Lysecki PJ, Sandhanwalia SK, Sharma SV. Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma-System Performance Improvement and Knowledge Exchange (T-SPIKE) project. Can J Surg 2021; 64:E162-E172. [PMID: 33720676 PMCID: PMC8064245 DOI: 10.1503/cjs.000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background There is currently no integrated data system to capture the true burden of injury and its management within Ontario’s regional trauma networks (RTNs), largely owing to difficulties in identifying these patients across the multiple health care provider records. Our project represents an iterative effort to create the ability to chart the course of care for all injured patients within the Central South RTN. Methods Through broad stakeholder engagement of major health care provider organizations within the Central South RTN, we obtained research ethics board approval and established data-sharing agreements with multiple agencies. We tested identification of trauma cases from Jan. 1 to Dec. 31, 2017, and methods to link patient records between the various echelons of care to identify barriers to linkage and opportunities for administrative solutions. Results During 2017, potential trauma cases were identified within ground paramedic services (23 107 records), air medical transport services (196 records), referring hospitals (7194 records) and the lead trauma hospital trauma registry (1134 records). Linkage rates for medical records between services ranged from 49% to 92%. Conclusion We successfully conceptualized and provided a preliminary demonstration of an initiative to collect, collate and accurately link primary data from acute trauma care providers for certain patients injured within the Central South RTN. Administration-level changes to the capture and management of trauma data represent the greatest opportunity for improvement.
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Affiliation(s)
- Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Angela Coates
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Russell D MacDonald
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Mahvareh Ahghari
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Michelle Welsford
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Tim Dodd
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Katie Turcotte
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jeffrey D Doyle
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Arthur M Eugenio
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jason P Green
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - J Eric Irvine
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Paul J Lysecki
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Simerpreet K Sandhanwalia
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Sunjay V Sharma
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
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9
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Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, Nathens AB, Eskander A. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. Laryngoscope 2020; 131:E1109-E1116. [PMID: 32894596 DOI: 10.1002/lary.29088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes. STUDY DESIGN Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database. METHODS Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level. RESULTS In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]). CONCLUSIONS Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury. LEVEL OF EVIDENCE Level 3 Laryngoscope, 131:E1109-E1116, 2021.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew P Guttman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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10
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Timeliness of Care for Injured Patients Initially Seen at Freestanding Emergency Departments: A Pilot Quality Improvement Project. Qual Manag Health Care 2020; 29:95-99. [PMID: 32224793 DOI: 10.1097/qmh.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of freestanding emergency departments (FSEDs) on timeliness of care for trauma patients is not well understood. This quality improvement project had 2 objectives: (1) to determine whether significant delays in definitive care existed among trauma patients initially seen at FSEDs compared with those initially seen at other outlying sites prior to transfer to a level I trauma center; and (2) to determine the feasibility of identifying differences in time-to-definitive care and emergency department length of stay (ED LOS) based on initial treatment location. METHODS Trauma registry data from January 1, 2017, through December 31, 2017, from a verified level I trauma center were analyzed by location of initial presentation. Appropriate statistical tests are used to make comparisons across transport groups. RESULTS Patients initially seen at non-FSEDs experienced ED LOS that were, on average, 24.5 minutes greater than patients seen initially at FSEDs, although the difference was not statistically significant (P = .3112). Several challenges were identified in the feasibility analysis that will inform the design for a larger study including large quantities of missing time stamp data and potential selection bias. Prospective solutions were identified. CONCLUSION This project found that there were not significant differences in ED LOS for injured patients presenting initially to FSEDs or other non-FSED facilities, suggesting that timeliness of care was similar across location types.
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Santana MJ, Ahmed S, Lorenzetti D, Jolley RJ, Manalili K, Zelinsky S, Quan H, Lu M. Measuring patient-centred system performance: a scoping review of patient-centred care quality indicators. BMJ Open 2019; 9:e023596. [PMID: 30617101 PMCID: PMC6326310 DOI: 10.1136/bmjopen-2018-023596] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The shift to the patient-centred care (PCC) model as a healthcare delivery paradigm calls for systematic measurement and evaluation. In an attempt to develop patient-centred quality indicators (PC-QIs), this study aimed to identify quality indicators that can be used to measure PCC. METHODS Design: scoping review. DATA SOURCES studies were identified through searching seven electronic databases and the grey literature. Search terms included quality improvement, quality indicators, healthcare quality and PCC. Eligibility Criteria: articles were included if they mentioned development and/or implementation of PC-QIs. DATA EXTRACTION AND SYNTHESIS extracted data included study characteristics (country, year of publication and type of study/article), patients' inclusion in the development of indicators and type of patient populations and point of care if applicable (eg, in-patient, out-patient and primary care). RESULTS A total 184 full-text peer-reviewed articles were assessed for eligibility for inclusion; of these, 9 articles were included in this review. From the non-peer-reviewed literature, eight documents met the criteria for inclusion in this study. This review revealed the heterogeneity describing and defining the nature of PC-QIs. Most PC-QIs were presented as PCC measures and identified as guidelines, surveys or recommendations, and therefore cannot be classified as actual PC-QIs. Out of 502 ways to measure PCC, only 25 were considered to be actual PC-QIs. None of the identified articles implemented the quality indicators in care settings. CONCLUSION The identification of PC-QIs is a key first step in laying the groundwork to develop evidence-based PC-QIs. Research is needed to continue the development and implementation of PC-QIs for healthcare quality improvement.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sadia Ahmed
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Rachel J Jolley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
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Doktorchik C, Manalili K, Jolley R, Gibbons E, Lu M, Quan H, Santana MJ. Identifying Canadian patient-centred care measurement practices and quality indicators: a survey. CMAJ Open 2018; 6:E643-E650. [PMID: 30563920 PMCID: PMC6298869 DOI: 10.9778/cmajo.20170143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient-centred quality indicators allow health care systems to monitor and evaluate patient-centred care practices and identify gaps in health care quality. Our objective was to determine whether Canadian provinces and territories measure patient-centred care, identify patient-centred quality indicators currently being used and compare patient-centred care practices and measurement in Canada to those of health care systems in other countries. METHODS An online survey was developed to collect data on demographic characteristics, patient-centred care practices, and indicators used at quality improvement organizations and health care authorities. The survey was conducted with quality improvement leads in Canada and 4 other countries. Content analysis methods were used to analyze and report the data. Patient-centred quality indicators were identified and categorized according to the Donabedian framework (structure, process, outcome). RESULTS The survey had a response rate of 47/67 (70%) and a completion rate of 58/60 (97%). We obtained completed surveys from 12 of the 13 provinces and territories in Canada. Respondents from most provinces indicated their organization used patient-centred care measures to inform practices. Respondents in only 4 provinces/territories reported using patient-centred quality indicators, for a total of 61 unique indicators. Most indicators used across Canada assessed aspects of care related to the Donabedian components of process and outcome. Findings for Canada were comparable to those for Sweden, England, Australia and New Zealand, where many measures are still in development. INTERPRETATION This study provided greater insight into patient-centred care measurement across Canada, Sweden, England, Australia and New Zealand and helped us to identify patient-centred quality indicators currently in use. These results will inform the development of a standard set of patient-centred quality indicators for implementation by health care organizations to improve the quality of health care.
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Affiliation(s)
- Chelsea Doktorchik
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Kimberly Manalili
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Rachel Jolley
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Elizabeth Gibbons
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Mingshan Lu
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Hude Quan
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
| | - Maria J Santana
- Departments of Community Health Sciences (Doktorchik, Manalili, Jolley, Quan, Santana) and Economics (Lu), University of Calgary, Calgary, Alta.; Health Services Research Unit (Gibbons), Nuffield Department of Population Health, University of Oxford, UK
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Veronese JP, Wallis L, Allgaier R, Botha R. Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance. Afr J Emerg Med 2018; 8:6-11. [PMID: 30456138 PMCID: PMC6223582 DOI: 10.1016/j.afjem.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/10/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Survival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting. METHODS A descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills. RESULTS Overall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training. CONCLUSION Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.
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Affiliation(s)
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Rachel Allgaier
- Division of Emergency Medicine, Stellenbosch University, South Africa
| | - Ryan Botha
- Faculty of Science, University of Fort Hare, South Africa
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Zdziarski-Horodyski L, Horodyski M, Sadasivan KK, Hagen J, Vasilopoulos T, Patrick M, Guenther R, Vincent HK. An integrated-delivery-of-care approach to improve patient reported physical function and mental wellbeing after orthopedic trauma: study protocol for a randomized controlled trial. Trials 2018; 19:32. [PMID: 29325583 PMCID: PMC5765655 DOI: 10.1186/s13063-017-2430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthopedic trauma injury impacts nearly 2.8 million people each year. Despite surgical improvements and excellent survivorship rates, many patients experience poor quality of life (QOL) outcomes years later. Psychological distress commonly occurs after injury. Distressed patients more frequently experience rehospitalizations, pain medication dependence, and low QOL. This study was developed to test whether an integrative care approach (IntCare; ten-step program of emotional support, education, customized resources, and medical care) was superior to usual care (UsCare). The primary aim was to assess patient functional QOL (objective and patient-reported outcomes) with secondary objectives encompassing emotional wellbeing and hospital outcomes. The primary outcome was the Lower Extremity Gain Scale score. METHODS/DESIGN A single-blinded, single-center, repeated measures, randomized controlled study is being conducted with 112 orthopedic trauma patients aged 18-85 years. Patients randomized to the IntCare group have completed or are receiving a guided ten-step support program during acute care and at follow-up outpatient visits. The UsCare group is being provided the standard of care. Patient-reported outcomes and objective functional measures are collected at the hospital and at weeks 2, 6, and 12 and months 6 and 12 post surgery. The main study outcomes are changes in Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires of Physical Function quality of life, Satisfaction with Social Roles, and Positive-Illness Impact, Post-Traumatic Stress Disorder Check List, and the Tampa Scale of Kinesiophobia-11 from baseline to month 12. Secondary outcomes are changes in objective functional measures of the Lower Extremity Gain Scale, handgrip strength, and range of motion of major joints from week 2 to month 12 post surgery. Clinical outcomes include hospital length of stay, medical complications, rehospitalizations, psychological measures, and use of pain medications. A mixed model repeated measures approach assesses the main effects of treatment and time on outcomes, as well as their interaction (treatment × time). DISCUSSION The results from this study will help determine whether an integrative care approach during recovery from traumatic orthopedic injury can improve the patient perceptions of physical function and emotional wellbeing compared to usual trauma care. Additionally, this study will assess the ability to reduce the incidence or severity of psychological distress and mitigate medical complications, readmissions, and reduction of QOL after injury. TRIAL REGISTRATION ClinicalTrials.gov, NCT02591472 . Registered on 28 October 2015.
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Affiliation(s)
| | - MaryBeth Horodyski
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Kalia K Sadasivan
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Jennifer Hagen
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Terrie Vasilopoulos
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA.,Departments of Anesthesia, University of Florida, Gainesville, FL, 32608, USA
| | - Matthew Patrick
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA
| | - Robert Guenther
- Departments of Clinical Psychology, University of Florida, Gainesville, FL, 32608, USA
| | - Heather K Vincent
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32608, USA.
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Jolley RJ, Lorenzetti DL, Manalili K, Lu M, Quan H, Santana MJ. Protocol for a scoping review study to identify and classify patient-centred quality indicators. BMJ Open 2017; 7:e013632. [PMID: 28057655 PMCID: PMC5223714 DOI: 10.1136/bmjopen-2016-013632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centred approach. In this paper, we outline our scoping review protocol to systematically review published and unpublished literature specific to patient-centred quality indicators that have been implemented and evaluated across various care settings. METHODS AND ANALYSIS Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. We will search electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts), grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. 2 reviewers will independently screen all abstracts and full-text studies for inclusion. We will include any study which focuses on quality indicators in the context of PCC. All bibliographic data, study characteristics and indicators will be collected and analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. ETHICS AND DISSEMINATION The scoping review will synthesise patient-centred quality indicators and their characteristics as described in the literature. This review will be the first step to formally identify what quality indicators have been used to evaluate PCC across the healthcare continuum, and will be used to inform a stakeholder consensus process exploring the development of a generic set of patient-centred quality indicators applicable to multiple care settings. The results will be disseminated through a peer-reviewed publication, conference presentations and a one-day stakeholder meeting.
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Affiliation(s)
- Rachel J Jolley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Boyd JM, Moore L, Atenafu EG, Hamid JS, Nathens A, Stelfox HT. A retrospective cohort study of the relationship between quality indicator measurement and patient outcomes in adult trauma centers in the United States. Injury 2017; 48:13-19. [PMID: 27847191 DOI: 10.1016/j.injury.2016.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Improving care is a key strategy for reducing the burden of injuries, but it is unknown whether the use of quality indicators (QI) is associated with patient outcomes. We sought to evaluate the association between the use of QIs by trauma centers and outcomes in adult injury patients. METHODS We identified consecutive adult patients (n=223,015) admitted to 233 verified trauma centers January 1, 2007 to December 31, 2010 that contributed data to the National Trauma Data Bank and participated in a survey of QI practices. Generalized Linear Mixed Models were employed to evaluate the association between the intensity (number of QIs) and nature (report cards, internal and external benchmarking) of QI use and survival to hospital discharge, adjusting for patient and hospital characteristics. RESULTS There were no significant differences in the odds of survival to trauma center discharge according to the number of QIs measured (quartiles; odds ratio{OR} [95% confidence interval{CI}] 1.00 vs. 1.08 [0.90-1.31] vs. 1.00 [0.82-1.22] vs. 1.21 [0.99-1.49]), or whether centers used reports cards (OR 1.07, 95%CI 0.94-1.23), internal (OR 1.06, 95%CI 0.89-1.26) or external (OR 1.09, 95%CI 0.92-1.31) benchmarking. The duration (geometric mean) of mechanical ventilation (4.0days), ICU stay (4.6days), hospital stay (7.7days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use. CONCLUSIONS The intensity and nature of the QIs used by trauma centers was not associated with outcomes of patient care. Alternative quality improvement strategies may be needed.
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Affiliation(s)
- Jamie M Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; W21C Research and Innovation Center, Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
| | - Eshetu G Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | - Jemila S Hamid
- Li Ka Shing Knowledge Institute, St. Micheal's Hospital, Toronto, Canada; Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Avery Nathens
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada.
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Hörster AC, Kulla M, Brammen D, Lefering R. [Potential for the survey of quality indicators based on a national emergency department registry : A systematic literature search]. Med Klin Intensivmed Notfmed 2016; 113:409-417. [PMID: 27357841 DOI: 10.1007/s00063-016-0180-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emergency department processes are often key for successful treatment. Therefore, collection of quality indicators is demanded. A basis for the collection is systematic, electronic documentation. The development of paper-based documentation into an electronic and interoperable national emergency registry is-besides the establishment of quality management for emergency departments-a target of the AKTIN project. The objective of this research is identification of internationally applied quality indicators. METHODS For the investigation of the current status of quality management in emergency departments based on quality indicators, a systematic literature search of the database PubMed, the Cochrane Library and the internet was performed. RESULTS Of the 170 internationally applied quality indicators, 25 with at least two references are identified. A total of 10 quality indicators are ascertainable by the data set. An enlargement of the data set will enable the collection of seven further quality indicators. The implementation of data of care behind the emergency processes will provide eight additional quality indicators. CONCLUSION This work was able to show that the potential of a national emergency registry for the establishment of quality indicators corresponds with the international systems taken into consideration and could provide a comparable collection of quality indicators.
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Affiliation(s)
- A C Hörster
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Ostmerheimer Straße 200, 51109, Köln, Deutschland.
| | - M Kulla
- Klinik für Anästhesie und Intensivmedizin - Sektion Notfallmedizin, RTH-Station "Christoph 22", Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - D Brammen
- Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg A.ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - R Lefering
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Ostmerheimer Straße 200, 51109, Köln, Deutschland
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Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S414-35. [PMID: 26472993 DOI: 10.1161/cir.0000000000000259] [Citation(s) in RCA: 610] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Establishing components of high-quality injury care: Focus groups with patients and patient families. J Trauma Acute Care Surg 2014; 77:749-756. [PMID: 25494428 DOI: 10.1097/ta.0000000000000432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families. The purpose of this study was to explore the views of patients and families affected by injury on desired components of injury care in the hospital setting. METHODS With the use of a grounded theory approach, this qualitative study involved focus groups with injured patients, family members of survivors, and bereaved family members from four Canadian trauma (injury care) centers. RESULTS Thirty-eight participants included injured patients (n = 16), family members of survivors (n = 13), and bereaved family members (n = 9) across four trauma (injury care) centers in different jurisdictions. Participants articulated numerous themes reflecting important components of injury care organized across three domains as follows: clinical care (staff availability, professionalism, physical comfort, adverse events), holistic care (patient wellness, respect for patient and family, family access to patient, family wellness, hospital facilities, supportive care), and communication and information (among staff, with or from staff, content, delivery, and timing). Bereaved family members commented on decision making and end-of-life processes. Subthemes were revealed in most of these themes. Trends by site or type of participant were not identified. CONCLUSION The framework of patient- and family-derived components of quality injury care could be used by health care managers and policy makers to guide quality improvement efforts. Further research is needed to extend and validate these components among injured patients and families elsewhere. Translating these components into quality indicators and blending those with measures that reflect a provider perspective may offer a comprehensive means of assessing injury care.
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Beuran M, Negoi I, Paun S, Vartic M, Stoica B, Tănase I, Negoi RI, Hostiuc S. Quality management in general surgery: a review of the literature. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60057-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
BACKGROUND Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status. QUESTIONS/PURPOSES We compared India and Germany in terms of (1) vehicular infrastructure and causes of road traffic accident-related trauma, (2) burden of trauma, and (3) current trauma care and prevention, and (4) based on these observations, we suggested how India and other countries can enhance trauma care and prevention. METHODS Data for Germany were obtained from federal statistical databases, German Automobile Club, and German Trauma Registry. Data from India were available from the Ministry of Road Transport and Highways. We also performed a standardized literature search of PubMed for India and Germany using the following key words: "road traffic accidents", "prevention", "prehospital trauma care", "trauma system", "trauma registry", "trauma centers", and "development of vehicles." RESULTS The total number of registered motor vehicles increased 473-fold in India and 100-fold in Germany from 1951 to 2011. The number of road traffic deaths increased in both countries until 1970, but thereafter decreased in Germany (3606 in 2012) while continuing to increase in India (142,485 in 2011). The differences between Germany and India relate to the relative sizes and populations of the countries (1:9 and 1:15, respectively), and differences in prevention and prehospital care (nationwide versus big cities) and hospital trauma systems (nationwide versus exceptional). CONCLUSIONS Improvement requires attention to three major issues: (1) prevention through infrastructure, traffic laws, mandatory licensing; (2) establishment of a prehospital care system; and (3) establishment of regional trauma centers and a trauma registry.
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Affiliation(s)
- Hans-Joerg Oestern
- Department of Traumatology, Orthopaedics, and Neurotraumatology, AO Foundation, Schubertstraße 12, D-29223, Celle, Germany.
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Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013; 128:417-35. [PMID: 23801105 DOI: 10.1161/cir.0b013e31829d8654] [Citation(s) in RCA: 642] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.
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Curtis K, Chan DL, Lam MK, Mitchell R, King K, Leonard L, D'Amours S, Black D. The injury profile and acute treatment costs of major trauma in older people in New South Wales. Australas J Ageing 2013; 33:264-70. [PMID: 24520942 DOI: 10.1111/ajag.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. METHODS Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. RESULTS Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. CONCLUSION Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia; Department of Surgery, St George Hospital, The George Institute for Global Health, Sydney, New South Wales, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Bobrovitz N, Parrilla JS, Santana M, Straus SE, Stelfox HT. A qualitative analysis of a consensus process to develop quality indicators of injury care. Implement Sci 2013; 8:45. [PMID: 23594974 PMCID: PMC3639212 DOI: 10.1186/1748-5908-8-45] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
Abstract
Background Consensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators. Methods We performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes. Results We identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection. Conclusion Our study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.
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Affiliation(s)
- Niklas Bobrovitz
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Developing a patient and family-centred approach for measuring the quality of injury care: a study protocol. BMC Health Serv Res 2013; 13:31. [PMID: 23351430 PMCID: PMC3570378 DOI: 10.1186/1472-6963-13-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022] Open
Abstract
Background Quality indicators (QI) are used in health care to measure quality of service and performance improvement. Health care professionals and organizations caring for patients with injuries need information regarding the quality of care provided and the outcomes experienced in order to target improvement efforts. However, very little is known about the quality of injury care provided to individual patients and populations and even less about patients’ perspectives on quality of care. The absence of QIs that incorporate patient or family preferences, needs or values has been identified as an important gap in the science and practice of injury quality improvement. The primary objective of this research protocol is to develop and evaluate the first set of patient and family-centred QIs of injury care for critically injured patients Methods/design This mixed methods study is comprised of three Sub-Studies. Sub-Study A will utilize focus group methodology to describe the preferences, needs and values of critically injured patients and their family members regarding the quality of health care delivered. Qualitative content analysis of the transcripts will begin after the first completed focus group and will draw on grounded theory using a process of open, axial and selective coding. A panel of stakeholders will be assembled during Sub-Study B to review the themes identified from the focus groups and develop a catalogue of potential patient and family-centred QIs of injury care using the RAND/UCLA Appropriateness Method (RAM). The QIs developed by the stakeholder panel will be pilot tested in Sub-Study C using surveys of patients and their family members to determine construct validity, intra-rater reliability and clinical sensibility. Discussion Measuring the quality of injury care is but a first step towards improving patient outcomes. This research will develop the first set of patient and family-centred QIs of injury care. To improve patient care, we need accessible, reliable indicators of quality that are important to patients, and that can then be used to establish quality of care benchmarks, to flag potential problems or successes, follow trends over time and identify disparities across organizations, communities, populations and regions.
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