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Use of performance reports among trauma medical directors and programme managers in the American College of Surgeons’ Trauma Quality Improvement Program: a qualitative analysis
  1. Lesley Gotlib Conn1,
  2. Christopher Hoeft2,
  3. Melanie Neal2,
  4. Avery Nathens1
  1. 1 Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
  2. 2 Trauma Quality Improvement Program, American College of Surgeons, Chicago, IL, USA
  1. Correspondence to Dr Lesley Gotlib Conn, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; lesley.gotlibconn{at}


Background The American College of Surgeons’ Trauma Quality Improvement Program (TQIP) provides trauma centres with performance reports on their processes and outcomes of care relative to their peers. This study explored how performance reports are used by trauma centre leaders to engage in performance improvement and perceived barriers to use.

Study design Qualitative focus group study with trauma medical directors (TMDs) and trauma programme managers (TPMs) in US trauma centres. Consistent with qualitative descriptive analysis, data collection and interpretation were inductively and iteratively completed. Major themes were derived using a constant comparative technique.

Results Six focus groups were conducted involving 22 TMDs and 22 TPMs. Three major themes were captured: (1) technical uses of performance reports; (2) cultural uses of performance reports; (3) opportunities to enhance the role and value of TQIP. First, technical uses included using reports to assess data collection procedures, data quality and areas of poor performance relative to peers. In this domain, barriers to report use included not trusting others’ data quality and challenges with report interpretation. Second, reports were used to influence practice change by fostering inter-specialty discussions, leveraging resources for quality improvement, community engagement and regional collaboratives. Perceived lack of specialist engagement was viewed as an impediment in this domain. Lastly, identified opportunities for TQIP to support report use involved clarifying the relationship between verification and performance reports, and increasing partnerships with nursing associations.

Conclusion Trauma centre improvement leaders indicated practical and social uses of performance reports that can affect intention and ability to change. Recommendations to optimise programme participation include a focus on data quality, adequate resource provision and enhanced support for regional collaboratives.

  • performance improvement
  • trauma center
  • quality improvement program
  • qualitative analysis

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  • Contributors All authors contributed to the conception and design of the study. LGC acquired the data. LGC and AN contributed to data analysis. LGC drafted the manuscript. All authors contributed edits and approved the final version of the manuscript.

  • Funding This study was funded by American College of Surgeons (

  • Competing interests AN is Medical Director of the American College of Surgeons’ trauma quality programmes. CH is Manager of Data and Report Operations at American College of Surgeons. MN is Program Manager, Trauma Quality Improvement Program at American College of Surgeons.

  • Patient consent for publication Obtained.

  • Ethics approval Sunnybrook Health Sciences Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.