Reducing Low-value Care for Trauma Admissions

Summary

In Canada, injury leads to more potential years of life lost and to greater costs than heart and stroke diseases combined. Furthermore, more than 50% of patients hospitalised following injury do not receive optimal care, 20% of injury deaths are estimated to be preventable, and significant variations in injury mortality and morbidity have been observed across trauma centers in Canada, the United Kingdom, Australia and the United States. Over the past decades, emphasis on adherence to evidence-based processes of care (rewards for doing more) and rapid innovation in imaging and therapeutic techniques has led to an exponential rise in unnecessary tests and procedures. Whole body computed tomography scan for single-system trauma is just one example. Low-value clinical practices, defined as "the common use of a particular intervention when the benefits don't justify the potential harm or cost" consume up to 30% of healthcare budgets. They expose patients to physical and psychological adverse events and put enormous pressure on healthcare budgets, thereby threatening accessible, universal health care. The objective of this research project is to evaluate the effectiveness of an intervention targeting reductions in low-value clinical practices for injury admissions. The results of this study should directly lead to improvements in the health systems across Canada and elsewhere. Medium and long-term advantages include an increase in healthcare efficiency and effectiveness, a reduction in costs, an increase in the availability of resources for patients who need them and a reduction in adverse events for patients hospitalized following injury.

Conditions

• Trauma Injury

Interventions

BEHAVIORAL

Audit & feedback with educational outreach and facilitation

As in arm descriptions

BEHAVIORAL

Simple audit & feedback (usual practice)

As in arm descriptions

Sponsors & Collaborators

• Institut national en santé et services sociaux

  collaborator UNKNOWN

• Trauma Association of Canada

  collaborator UNKNOWN

• Health Standards Organisation

  collaborator UNKNOWN

• Choosing Wisely Canada

  collaborator UNKNOWN

• Audit & Feedback Metalab

  collaborator UNKNOWN

• Institut national de la pertinence des actes médicaux

  collaborator UNKNOWN

• Laval University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

16 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-06-30

Primary Completion

2025-09-30

Completion

2026-12-31

Countries

• Canada

Study Locations