Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

The effect of trauma quality improvement programme implementation on quality of life among trauma patients in urban India

Kapitan, Eelika ; Berg, Johanna LU orcid ; David, Siddarth ; N, Mohan L. ; Felländer-Tsai, Li ; Chatterjee, Shamita ; Ekelund, Ulf LU orcid ; Roy, Nobhojit ; Petzold, Max and Von Schreeb, Johan , et al. (2025) In Injury 56(6).
Abstract

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the... (More)

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Low- and middle-income countries, Quality improvement, Quality of life, Trauma, Trauma quality improvement programme
in
Injury
volume
56
issue
6
article number
112333
publisher
Elsevier
external identifiers
  • scopus:105003832906
  • pmid:40311153
ISSN
0020-1383
DOI
10.1016/j.injury.2025.112333
language
English
LU publication?
yes
id
3fdd3e9a-2b98-401a-8c18-beec8c9ac2dd
date added to LUP
2025-07-18 10:55:58
date last changed
2025-07-19 03:04:39
@article{3fdd3e9a-2b98-401a-8c18-beec8c9ac2dd,
  abstract     = {{<p>Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.</p>}},
  author       = {{Kapitan, Eelika and Berg, Johanna and David, Siddarth and N, Mohan L. and Felländer-Tsai, Li and Chatterjee, Shamita and Ekelund, Ulf and Roy, Nobhojit and Petzold, Max and Von Schreeb, Johan and Soni, Kapil Dev and Rajan, Sendhil and Khajanchi, Monty and Wärnberg, Martin Gerdin}},
  issn         = {{0020-1383}},
  keywords     = {{Low- and middle-income countries; Quality improvement; Quality of life; Trauma; Trauma quality improvement programme}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{Elsevier}},
  series       = {{Injury}},
  title        = {{The effect of trauma quality improvement programme implementation on quality of life among trauma patients in urban India}},
  url          = {{http://dx.doi.org/10.1016/j.injury.2025.112333}},
  doi          = {{10.1016/j.injury.2025.112333}},
  volume       = {{56}},
  year         = {{2025}},
}