Browsing by Author "Bobrovitz, Niklas"

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    Development and Validation of the Quality of Trauma Care Patient-Reported Experience Measure
    (2014-01-29) Bobrovitz, Niklas; Stelfox, Henry Thomas
    To deliver patient-centered injury care, patient perspectives must be incorporated into quality measurement and improvement. Therefore, the purpose of this thesis was to develop and validate a measure of patient experience for use as a quality improvement tool in injury care. A draft survey measure of patient injury care experience was revised using cognitive interviews with 30 injury patients/surrogates. A multi-site prospective cohort study of 400 patients/surrogates was conducted and provided evidence of the measure's validity, reliability, and feasibility of implementation. Analysis of responses to the free-text items on the measure indicated that qualitative data obtained from open-ended items may be a valuable supplement to the quantitative component of the measure. The results of this thesis show that the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM) is valid and reliable and could be used as a tool to guide quality improvement efforts.
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    Development of the quality of teen trauma acute care patient and parent-reported experience measure
    (2022-09-23) Yeung, Matthew; Hagel, Brent E.; Bobrovitz, Niklas; Stelfox, Thomas H.; Yanchar, Natalie L.
    Abstract Objective Patient-Reported Experience Measures (PREMs) provide valuable patient feedback on quality of care and have been associated with clinical outcomes. We aimed to test the reliability of a modified adult trauma care PREM instrument delivered to adolescents admitted to hospital for traumatic injuries, and their parents. Modifications included addition of questions reflecting teen-focused constructs on education supports, social network maintenance and family accommodation. Results Forty adolescent patients and 40 parents participated. Test-retest reliability was assessed using Cohen’s kappa, weighted kappa, and percent agreement between responses. Directionality of changed responses was noted. Most of the study ran during the COVID-19 pandemic. We established good reliability of questions related to in-hospital and post-discharge communication, clinical and ancillary care and family accommodation. We identified poorer reliability among constructs reflecting experiences that varied from the norm during the pandemic, which included “maintenance of social networks”, “education supports”, “scheduling clinical follow-ups” and “post-discharge supports”. Parents, but not patients, demonstrated more directionality of change of responses by responding with more negative in-hospital and more positive post-discharge experiences over time between the test and retest periods, suggesting risk of recall bias. Situational factors due to the COVID-19 pandemic and potential risks of recall bias may have limited the reliability of some parts of the survey.
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    Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review
    (2021-03-11) Roberts, Derek J.; Bobrovitz, Niklas; Zygun, David A.; Kirkpatrick, Andrew W.; Ball, Chad G.; Faris, Peter D.; Stelfox, Henry T.
    Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.
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    Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments
    (2018-07-26) Bobrovitz, Niklas; Heneghan, Carl; Onakpoya, Igho; Fletcher, Benjamin; Collins, Dylan; Tompson, Alice; Lee, Joseph; Nunan, David; Fisher, Rebecca; Scott, Brittney; O’Sullivan, Jack; Van Hecke, Oliver; Nicholson, Brian D; Stevens, Sarah; Roberts, Nia; Mahtani, Kamal R
    Abstract Background Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement. Methods This was a systematic review of systematic reviews. We searched MEDLINE, PubMed, the Cochrane Database of Systematic Reviews & Database of Abstracts of Reviews of Effects, Google Scholar and the websites of ten major funding agencies and health charities, using broad search criteria. We included systematic reviews of randomised controlled trials that examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality of reviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysed effect estimates and cross-referenced the evidence with clinical guidelines. Results We identified 140 systematic reviews, which included 1968 unique randomised controlled trials and 925,364 patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidence for 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the United States, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary artery disease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department and anticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics). Conclusions We identified 11 medications supported by strong evidence and clinical guidelines that could be considered in quality monitoring and improvement strategies to help reduce emergency hospital admission rates. The findings are relevant to health systems with a large burden of chronic disease and those managing increasing pressures on acute health-care services.
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    A qualitative analysis of a consensus process to develop quality indicators of injury care
    (BioMed Central, 2013-04-18) Bobrovitz, Niklas; Parrilla, Julia S; Santana, Maria; Straus, Sharon E; Stelfox, Henry T
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    Short form version of the Quality of Trauma Care Patient-Reported Experience Measure (SF QTAC-PREM)
    (2017-12-06) Bobrovitz, Niklas; Santana, Maria J; Boyd, Jamie; Kline, Theresa; Kortbeek, John; Widder, Sandy; Martin, Kevin; Stelfox, Henry T
    Abstract Objective To enable the valid and reliable measurement of patient experiences we previously published a multicenter multi-center validation of the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM). The purpose of this study was to derive a simplified, short form version of the QTAC-PREM to further enhance the feasibility of measuring patient experiences in injury care. To identify candidate items for the short form we reviewed the results of the original multi-center long form validation cohort study, which included 400 injury care patients and their family members recruited from three trauma centers. We only included the best performing items on the revised short form. Results The acute care component of the measure was shortened by 30% and the post-acute care component was shortened by 42%. We identified two subscales on the acute measure (information and communication; clinical and ancillary care) and one subscale on the post-acute measure (post-discharge information and communication). The measurement properties of the short form measure were similar to that of the validated long form. This short form assessment of patient injury care experiences offers a useful, practical, and easy tool for trauma centers to implement for service evaluation, quality improvement, and injury care research.