Building Capacity for Trauma Quality Improvement: An Innovative Pilot Program in Cameroon to Address the Burden of Injury

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Investigator: Catherine Juillard, MD, MPH
Sponsor: NIH John F. Fogarty International Center

Location(s): Cameroon

Description

The proposed project is relevant to public health because trauma kills more people annually than HIV, malaria, and tuberculosis combined, with 90% of these deaths occurring in low- and middle-income countries. Powerful tools that have shown to improve trauma care in high-income countries, like quality improvement programs, have not been adapted to settings in low- and middle-income countries; we propose to do this. The project is relevant to NIH’s mission because it seeks to lengthen the lives of trauma patients and to reduce or eliminate any subsequent disabilities.

As injuries become an increasingly important public health priority in low- and middle-income settings, including sub-Saharan Africa (SSA), context-appropriate methodologies for developing improvements in systems of trauma care are lacking. Although several pilot trauma registries have been created in SSA, correlative processes to use registry data for injury control interventions, like trauma quality improvement (QI), are urgently needed. Without appropriate methodology, trauma registries and other surveillance tools in SSA will remain powerless to create actionable change. Cameroon appears to be more affected by injury than other countries in the region. Our long-term goal is to reduce the impact of injury in Cameroon and other parts of SSA through development of an integrated trauma system, of which trauma QI is a key component. The overall objective of this application is to build on an existing centralized trauma registry by developing trauma QI methodology appropriate for the Cameroonian context and generalizable to other similar SSA settings, which is the next step toward attainment of our long-term goal. Using trauma registries to develop QI processes and interventions will provide a direct mechanism for improved patient care that will be exportable to other similar SSA settings and other health systems for non-communicable diseases or injury control. To accomplish the objective of this application, we will pursue four specific aims:
1) Establish and train a peer-driven trauma care QI committee in Cameroon that can perform comprehensive case review and root cause analysis to identify specific correctable deficiencies;
2) Train four “QI fellows” and a QI program manager to develop research and analytic skills in QI methodology, monitoring, and evaluation;
3) Apply the QI process to refine the existing trauma registry data collection tool, enhancing its capacity to capture changes in the quality of clinical care delivery; and
4) Implement QI committee meetings to propose context-appropriate trauma QI interventions for future implementation in Cameroon and similar settings.
This contribution will create novel, locally-relevant trauma QI methods and context-appropriate treatment strategies that can be implemented in Cameroon and other SSA countries with the expected result of improving trauma care and injury control. These QI methods and treatment strategies will serve as a “roadmap” for how to use trauma registry data and QI methodology to improve clinical trauma care through actionable interventions that are targeted, evidence-based, and context- appropriate. The development of a culturally-relevant, peer-driven comprehensive QI process is novel. Embedded in our approach is the training of clinicians in the process of QI and the scientific methods by which to conduct QI analysis. This research initiative is the vital step towards ultimately creating a core group of clinician scientists with the skills to disseminate the QI process, and developing a network of individuals who can create a culture of research-based improvements in the care of the injured.