Grant: Foundation Grant

Injuries lead to 200,000 hospital stays, 60,000 disabilities, and 13,000 deaths per year in Canada with direct costs of $20b. Up to 30% of healthcare budgets are spent on potentially unnecessary tests and procedures (e.g. scans, blood transfusions, surgeries), exposing patients to avoidable harm. Our research team has pioneered the development of indicators to assess the underuse of clinical processes in acute injury care. These indicators have been incorporated into provincial and national trauma center accreditation procedures and have led to improvements in clinical processes and decreases in mortality and length of hospital stay. A natural extension of this work, the Canadian Program for Monitoring Overuse in Injury Care, detailed in this proposal, will develop Indicators targeting the use of low-value processes (overuse) in injury care. To do so, we will: 1. Identify low-value processes in injury care 2. Review the evidence base for low-value processes 3. Develop and validate Indicators to measure the use of low-value processes 4. Identify patient, physician and hospital determinants of overuse and assess its impact on patient mortality, morbidity and resource use 5. Evaluate the impact of disseminating Indicators in a quality report on overuse and patient outcomes. The indicators developed in this research program will be used to identify problems of medical overuse in trauma systems across Canada and worldwide. These results will be used by local trauma committees, hospital administrators and trauma system managers to optimize the use of tests and procedures, ultimately reducing the societal and economic burden of injury. Potential benefits include an increase in the efficiency and a decrease in the costs of injury care, an increase in the availability of scarce resources and a reduction in adverse events.