Influence of trauma system implementation on process of care delivered to seriously injured patients in rural trauma centers

Background. Statewide trauma systems are implemented by health care policy makers whose intent is to improve the process of care delivered to seriousl y injured patients. In Oregon, Advanced Trauma Life Support (ATLS) training was mandated for all physicians employed in the emergency department of tr auma centers. The purpose of this study was to test the hypothesis that man datory ATLS training favorably influenced processes of care. Methods. Seriously injured patients treated at 9 rural Level 3 and Level 4 hospitals were studied before (PRE) and after (POST) implementation of Oreg on's trauma system. The processes of care evaluated on the basis of chart r eview were 20 diagnostic and therapeutic interventions advocated in the ATL S course. A cumulative process score (CPS) between 0 and 1 was assigned on the basis of the processes of care delivered. A CPS of I indicated optimal process of care. Results. Mean CPS for 506 PRE Period Patients (0.44 +/- 0.27) was significa ntly lower than the mean CPS for 512 POST period patients (0.57 +/- 0.27) w ith an unpaired t test (P < .001). For the subgroup with injury severity sc ore of 16 to 34, the mean CPS of survivors (0.67 +/- 0.19) was significantl y higher than the mean CPS of decedents (0.57 +/- 0.25). Conclusions. Process of care for seriously injured patients improved after categorization of rural trauma centers in Oregon. Evidence shows improved p rocess of care may have benefitted patients with serious but survivable inj uries. Measurement of process of care is an alternative to mortality analys is as an indication of the quality of care.