Measuring quality in trauma care.

For use in quality measurement, a quality indicator (QI) must satisfy a number of criteria: there needs to be an established link with outcome; the indicator needs to measure what is considered current accepted practice; the targeted population requires precise definition; an appropriate risk adjustment strategy must be employed; the indicator should be feasible for collection; and, the measure must apply to a sufficient number of people so as to provide a measure of system-wide quality. This article discusses the use of QIs in the care of trauma patients. A series of QIs were originally promulgated by the American College of Surgeons Committee on Trauma (ACSCOT) and have been investigated for their utility in measuring quality in trauma systems by a number of US based studies. While some have advocated the implementation of several specific indicators, others have recommended discontinued use of a range of proposed QIs. This review highlights the difficulties of meeting these ideal indicator requirements in trauma care and proposes that the development of alternative indicators may provide more useful measures of quality care.