An environmental scan of public domain reporting on injury and trauma in British Columbia

Introduction: High quality trauma care and effective injury prevention and control in regionally discrete populations are prime objectives of mature trauma systems. In British Columbia, where 4.6 million people inhabit a vast area of one million square kilometers, numerous independent agencies and organizations with varying performance objectives guided by large independent data collection strategies support this collective effort. Whole system measures are an emerging evaluative tool useful to decision makers responsible for allocating resources to better align and integrate healthcare delivery services that result in meaningful system-level performance improvement. The usefulness of current performance reporting to drive improvement in the design and function of British Columbia’s systems of trauma care and injury management is unclear. Objectives: The research objectives were to (1) describe in qualitative and semi-quantitative terms the depth and breadth of public domain reporting on injury management in the province of British Columbia; (2) identify, if possible, measures that describe performance of the system as a whole; and (3) identify performance reporting gaps that, if addressed, may facilitate improvement in system design and function. Methods: (1) Identify all B.C agencies involved in the care, control and prevention of injury; (2) Identify performance objectives for the provincial trauma system through assessment of the strategic plans of leading trauma organizations; (3) Construct an inventory of public domain reporting by identified agencies; (4) Describe retrieved reports using qualitative and semi-quantitative methods; (5) Compare performance reporting output against overarching strategic performance objectives to identify gaps in whole system reporting. Results: We identified 276 injury-related performance measures from 19 data sets in 174 reports produced by 37 B.C. organizations from 1998-2013. All 13 domain trauma system were represented. Unadjusted mortality and stratified incidence rates from surveillance reporting predominated. EMS, acute hospital care and recovery care reporting was thin. While several metrics could be adopted as whole system measures, important gaps were identified. Conclusion: Public reporting of trauma care and injury management in B.C. does not reflect an integrated system unified by well aligned outcome objectives. A whole system measures approach to performance evaluation of the provincial trauma system could help to accomplish this.Surgery, Department ofMedicine, Faculty ofGraduat