Quality Indicators Targeting Low-Value Clinical Practices in Trauma Care

Area of Science:

• Trauma Care
• Quality Improvement
• Health Services Research

Background:

• Quality indicators are crucial for improving trauma care processes and patient outcomes.
• Existing trauma quality indicators primarily focus on the overuse of recommended practices, neglecting the reduction of low-value care.
• Few initiatives, like Choosing Wisely, offer guidance for trauma care, with limited success in translating into actionable quality indicators.

Purpose of the Study:

• To develop a consensus-based set of quality indicators for acute, in-hospital trauma care.
• These indicators aim to reduce low-value clinical practices, informed by evidence and patient priorities.
• The study focused on creating indicators that target specific areas of potential overuse or unnecessary interventions.

Main Methods:

• A 2-round Research and Development/University of California at Los Angeles (RAND/UCLA) consensus study was conducted.
• Two expert panels (international and local stakeholders, including patient partners) participated.
• Experts rated 50 practices on importance, evidence, actionability, and measurability using a 7-point Likert scale.

Main Results:

• Forty-six of 49 experts completed the consensus study.
• Eleven quality indicators were selected, targeting areas such as initial and repeated diagnostic imaging, consultations, surgery, blood product administration, medication use, and intensive care unit admission.
• Selected indicators focus on practices that should be questioned to reduce low-value care in trauma.

Conclusions:

• A set of consensus-based quality indicators was developed for trauma care, targeting low-value practices.
• These indicators are informed by evidence and patient priorities, providing a trauma-specific list of practices to question.
• High-income countries can utilize these findings to select and implement context-specific quality indicators to reduce low-value trauma care.