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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 379 records · Page 21Linked to original sources
PubMed1999

Community-based trauma system development: key barriers and facilitating factors.

BACKGROUND: Local progress in developing trauma systems has been slow, because of a variety of political, financial, social, and organizational challenges. The purpose of this study is to discuss effective community strategies for dealing with these obstacles to trauma system development. METHODS: In-depth case studies were conducted in 12 study sites across the United States. These communities had similar sociodemographic characteristics (e.g., resident populations of 1 million or more) but had varying progress in the development of trauma systems. RESULTS: Several factors were identified in community and leadership characteristics that promoted the development of comprehensive trauma systems. CONCLUSION: The most important strategies included broad-based participation of key stakeholders (especially community representatives), local trauma leaders who were patient and resourceful, local events (some of which were orchestrated) that demonstrated the need for change in trauma delivery, and financial programs that recognized the needs of trauma centers with high numbers of uninsured patients.

Community Health Planning↗
PubMed1999

Systematic review of published evidence regarding trauma system effectiveness.

OBJECTIVE: Provide a systematic review of the published literature assessing the affect of trauma center/system implementation on patient outcomes. DATA SOURCES: A bibliographic search of MEDLINE (1966-May of 1998), HealthSTAR (1995-May of 1998), and CINAHL (1982-May of 1998). Additional manuscripts were identified in the references of reviewed manuscripts. Literature was limited to English language reports on trauma systems in the United States and Canada. STUDY SELECTION: Initial inclusion criteria were based on methodologic criteria (i.e., a comparative [controlled] study). Authors independently assessed the strength of evidence demonstrated by each article. DATA EXTRACTION: Included articles were classified into three groups based on study design: panel review studies, trauma registry comparison studies, and population-based studies. Key demographic, sampling frame, study design, and outcome variables were tabulated for each included study. Potential sources of bias were also identified and tabled. DATA SYNTHESIS: A total of 12, 11, and 17 studies were incorporated into individual evidence tables for panel review, registry comparison, and population-based studies, respectively. Included studies rely on weak evidence (Class III) to assess the impact of trauma systems on patient care and outcome. CONCLUSIONS: To date, studies assessing trauma system efficacy rely on hospital deaths as the primary indicator of effectiveness. Future research should use more sophisticated study designs (Class II) and expand available outcome measures to assess the entire continuum of care, including prehospital, rehabilitation outcomes, and long-term quality of life.

Data Collection↗
PubMed1999

Review of evidence regarding trauma system effectiveness resulting from panel studies.

OBJECTIVE: The objectives this study are to elucidate the advantages and disadvantages of the panel method for evaluating the quality of trauma care and to review the individual and collective evidence in support of regionalized trauma care derived from these studies. METHOD: A review of the published literature was conducted and identified 10 panel studies that compared appropriateness of care and/or the preventability of deaths occurring either across hospitals in a trauma system versus non-trauma system, in a defined region before and after implementation of a trauma system, between trauma center and non-trauma center hospitals within a defined region, or across hospitals of varying levels of care presystem. RESULTS: Panel studies vary widely in the approaches used to elicit judgments; low rates of inter-rater reliability have been reported. The strength of the evidence derived from panel studies in support of trauma system effectiveness must be reviewed in this context. CONCLUSION: All panel studies are classified as providing weak, Class III evidence. Yet, collectively they provide some face validity in support of the hypothesis that treatment at a trauma versus non-trauma center may be associated with less inappropriate care and fewer preventable deaths among the seriously injured.

California↗
PubMed1999

Population-based research assessing the effectiveness of trauma systems.

OBJECTIVE: To review published evidence regarding the effectiveness of trauma systems by using population-based data. DESIGN: A systematic review of peer-reviewed literature assessing the influence of trauma system implementation on the outcome of all injured patients. MATERIALS AND METHODS: Literature available in MEDLINE, HealthSTAR, and CINHAL was reviewed for studies that use population-based data to assess the benefit of trauma system development. Studies were included that assessed trauma systems in North America and used a comparison or control group in the analysis. MAIN RESULTS: Published evidence, reported for eight of the nine trauma systems evaluated, demonstrates improved outcomes, principally measured as hospital survival. Improvement occurred after the trauma system or some component of a trauma system (e.g., sophisticated prehospital care) was established. CONCLUSION: Population-based evidence supports a 15 to 20% improved survival rate among seriously injured patients with trauma system implementation. Future study is required to determine whether trauma systems improve the outcome of all injured patients, not just high-risk subsets of the population.

Community Health Planning↗
PubMed1999

Assessing the effectiveness and optimal structure of trauma systems: a consensus among experts.

OBJECTIVE: To determine whether a consensus exists among experts regarding the effect of organized trauma systems on patient outcomes based on peer-reviewed, published evidence. Second, to ascertain whether experts agree on the optimal structure of trauma systems. METHODS: A multistage, longitudinal survey was administered to trauma system experts participating in a national symposium designed to assess the published evidence regarding trauma system effectiveness. Survey questions assessed published evidence by evaluating study designs, potential biases, and sample case mix. Trauma system structure was assessed by asking participants to rate the merit of previously identified key trauma system characteristics. Analyses were conducted using consensus theory. RESULTS: Ninety symposium participants (99%) completed all five surveys. Respondents considered the evidence to be "moderately supportive" of trauma system effectiveness when considering severely injured patients in urban settings. Several key trauma system characteristics were identified as mandatory or highly desirable components of trauma system implementation and maintenance. Experts currently favor exclusive rather than inclusive trauma systems. CONCLUSION: A consensus does exist among trauma system experts regarding the effectiveness of trauma systems and the optimal structure of trauma systems. Additional research is needed to determine whether trauma system benefits extend to other patient subgroups in other geographic regions. Consensus theory provides an impressive model for assessing rater agreement by controlling for response bias and providing a probability measure to determine whether a true consensus exists.

Canada↗
PubMed1992

Physician volume and obstetric outcome.

Although much has been written regarding regionalization of obstetric services and inferences made about centralization of labor and delivery, little data exist that specifically address the volume-outcome relationship for obstetrics. The purpose of this study was to determine the relationship between physician volume and perinatal outcome as measured by neonatal and perinatal mortality. A sample of 210,547 births to Missouri residents from 1984 to 1987 was studied using multivariate logistic regression with perinatal death and neonatal death as outcomes. No relationship was found between physician volume and outcome.

Birth Rate↗
PubMed2001

Mortality among seriously injured patients treated in remote rural trauma centers before and after implementation of a statewide trauma system.

BACKGROUND: Injury mortality in rural regions remains high with little evidence that trauma system implementation has benefited rural populations. OBJECTIVE: To evaluate risk-adjusted mortality in remote regions of Oregon before and after implementation of a statewide trauma system. RESEARCH DESIGN: A retrospective cohort study assessing injury mortality through 30 days after hospital discharge. SETTING: Nine rural Oregon hospitals serving counties with populations <18 persons per square mile. SUBJECTS: Severely injured patients presenting to four level-3 and five level-4 trauma hospitals 3 years before and 3 years after trauma system implementation. MEASURES: Interhospital transfer, hospital death, and demise within 30 days following hospital discharge. RESULTS: A total of 940 patients were analyzed. After trauma system implementation, patients presenting to level-4 hospitals were more likely transferred to level-2 facilities (P <0.001). Interhospital transfer times from level-3 hospitals lengthened significantly after system implementation (P <0.001). Overall mortality rates were higher in the postsystem period (8.3%) than the presystem period (6.7%), but not significantly. Controlling for covariates, no additional benefit to risk-adjusted mortality was associated with trauma system implementation. Additional deaths, occurring after trauma system implementation, included head-injured patients transferred from rural hospitals to nonlevel-1 trauma center hospitals. CONCLUSIONS: Increased injury survival after Oregon trauma system implementation, demonstrated in urban and statewide analyses, was not confirmed in remote regions of the state. Efforts to improve trauma systems in rural areas should focus on the processes of care for head-injured patients transferred to higher designation trauma centers.

Adult↗
PubMed2003

Trauma system evaluation using the fatality analysis reporting system.

BACKGROUND: The Fatality Analysis Reporting System (FARS) has recorded detailed data on fatal traffic crashes since 1975. At least three prior studies have used declining mortality rates derived from FARS as evidence of regional trauma system effectiveness. METHODS: FARS and census data were obtained at no cost through the Internet. Previously published studies were replicated graphically including data from additional years before and after the previously reported time periods, and with rates also calculated for control populations. RESULTS: The association of trauma system organization with observed decreases in mortality rates was less convincing when all available data were displayed and other potential factors were considered. Death after traffic crashes, and especially death in hospitals, is becoming less frequent throughout the country. CONCLUSION: FARS is an excellent resource available to all injury researchers, but provides little evidence that some regions have decreased traffic mortality more than others because of trauma systems.

Accidents, Traffic↗
PubMed1993

The Sigma Project.

The Sigma Project, underway in a number of health care settings across Trent Regional Health Authority, is making dramatic productivity gains and improvements in the quality of care. The Project is being spearheaded by a number of Trust chief executives and unit general managers.

Costs and Cost Analysis↗
PubMed2006

Evaluation of a national quality use of medicines service in Australia: an evolving model.

RATIONALE: To describe the first phase of a global evaluation framework for the National Prescribing Service (NPS), with a focus on services for health professionals, and in particular highlight the lessons learnt from evaluation around the establishment and implementation of this national program. METHODS: The agreed evaluation framework used mixed methods focused around a series of evaluation questions, aimed at measuring the overall effect of this new organization as well as the individual programs within it. The evaluation questions were determined a priori and were based on the objectives established by the organization in its first year of operation. A detailed analyses has been completed of: the process, scope and reach of program delivery using both quantitative and qualitative measures; changes in attitudes and knowledge measured through key informant interviews and surveys of professional groups and consumers; and changes in prescribing behaviour and savings to the Pharmaceutical Benefits Scheme (PBS) through analysis of prescription data. The evaluation period for this report was mid-1998 to mid-2004. RESULTS: The NPS has successfully implemented a complex, multi-faceted program across Australia. From 1998 to 2004, in addition to print material provided to all general practitioners (GPs) and pharmacists, 90% of all GPs have been actively involved in one or more educational activity; 116 of 120 divisions of general practice have coordinated local NPS programs; and 9% of pharmacists have actively participated in at least one educational activity. Sixty per cent of GPs and pharmacists rated the printed educational materials as good or very good. In the last three years, the NPS activities have generated savings in the range of $121-163 million to the PBS, owing to changes in prescribing practices. CONCLUSION: The national evaluation framework has informed program delivery and ongoing design and development. Continued refinement of existing evaluation methods and further exploration of new techniques will remain a priority for the organization.

Australia↗
PubMed2006

Developing the health promotion knowledge of the municipalities in South-Savo County in Finland.

Health determinants are not only biology and genetic endowment, but also income and social status, education, employment and working conditions, physical environment, social support networks, healthy childhood development, health services and personal health practices and coping skills. Successful health promotion means working together with local and regional authorities and politicians in every administrative sector in firm cooperation with health education, health professionals and local residents. The project for developing health promotion knowledge in management and decision-making contributes to the requirements of partnership working.

Attitude to Health↗
PubMed2003

Cost-effectiveness of USAID's regional program for family planning in West Africa.

Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

Adolescent↗
PubMed1989

The effect of a preterm birth prevention program in 17 rural and three urban counties in northwest North Carolina.

The results of a program of low birthweight prevention in 17 rural (20,727 births) and three urban counties (15,561 births) for calendar years 1985 and 1986 are described. Records for women in the program were matched with birth certificate data by computer. Rural and urban women in and out of the program were compared by race on the following risk factors: age less than 18 years, unmarried, education less than 12 years, Medicaid recipient, not WIC recipient, inadequate prenatal care, and previous fetal or live born death. Adjusting for these risk factors, logistic regression was used to estimate program effects on low birthweight (LBW), very low birthweight (VLBW), and preterm low birthweight (PLBW) among rural women. There was a statistically significant difference (p less than or equal to 0.01) favoring women in the program for very low birthweight and preterm low birthweight in white women, and low birthweight and preterm low birthweight in nonwhite women. The differences in rural areas exceed those in urban areas for all but one mean, very low birthweight births among white women.

Adolescent↗
PubMedDate not supplied

A regional diabetes nutrition education program: its effect on knowledge and eating behavior.

The effect of a nutrition education program on knowledge and self-care behavior in a group of individuals with diabetes was evaluated. The nutrition education program was developed using outlines and knowledge tests produced by the University of Michigan Diabetes Research and Training Center. The program, sponsored by the American Diabetes Association, Akron Chapter, was presented free of charge to Northeast Ohio area residents. Forty-four individuals participated in the study. Results indicated a statistically significant (p < 0.01) gain in knowledge but no statistically significant change in eating behavior for the sample. However, post-food records indicated that the mean for the percentage of total kcalories (kcals) from protein and fat (ie, 20% and 28%, respectively) were within the American Diabetes Association's recommendations of no more than 20% of kcals from protein and 30% of kcals from fat. In addition, the percentage of kcals from carbohydrate and the recommended total number of kcals improved toward the recommended levels.

Adult↗