Developing Performance Indicators for Trauma Care: A Four-Stage Qualitative Study

Document Type : Original Article


1 Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Iranian Center of Excellence in Health Management (IceHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

4 Emergency Medicine Research Team, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary.
Objectives: the present study aimed to develop some trauma care performance indicators.
Methods: This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment.
Results: A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators.
Conclusion: Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.


Volume 25, Issue 1
January and February 2020
Pages 34-51
  • Receive Date: 17 August 2019
  • Revise Date: 28 October 2019
  • Accept Date: 28 November 2019