Global Survey of Demand-Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation

• Published in: World journal of surgery Vol. 46; no. 5; pp. 1059 - 1066
• Main Authors: Stewart, Barclay T., Mehta, Kajal, Drago, Monique, Henry, Sharon, Joseph, Kimberly, Strong, Kathryn, Trostchansky, Julio L., Jorgensen, Jorgen Joakim, Leung, Gilberto Ka-Kit, Abi-Saad, George S., Bulger, Eileen, Mock, Charles
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Advanced Trauma Life Support Care; Best practice; Cardiac Surgery; Content analysis; Cross-Sectional Studies; Demand; Directors; Emergency medical services; General Surgery; Humans; Incentives; Leadership; Medicine; Medicine & Public Health; Motivation; Polls & surveys; Professional associations; Qualitative analysis; Response rates; Subsidies; Surgery; Surgery in Low and Middle Income Countries; Surveys and Questionnaires; Thoracic Surgery; Training; Trauma; Trauma care; Vascular Surgery; Verification; Wounds and Injuries - therapy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-022-06461-9

Background
We aimed to identify and describe demand-side factors that have been used to support ATLS global promulgation, as well as current gaps in demand-side incentives.
Methods
We performed a cross-sectional survey about demand-side factors that influence the uptake and promulgation of ATLS and other trauma-related CME courses. The survey was sent to each of the four global ATLS region chiefs and 80 ATLS country directors. Responses were described and qualitative data were analyzed using a content analysis framework.
Results
Representatives from 30 countries and each region chief responded to the survey (40% response rate). Twenty of 30 country directors (66%) reported that there were some form of ATLS verification requirements. ATLS completion, not current verification, was often the benchmark. Individual healthcare systems were the most common agency to require ATLS verification (37% of countries) followed by medical/surgical accreditation boards (33%), governments (23%), training programs (27%), and professional societies (17%). Multiple credentialing frameworks were reported including making ATLS verification a requirement for: emergency unit or trauma center designation (40%), contract renewal or promotion (37%); professional licensing (37%); training program graduation (37%); and increases in remuneration (3%). Unique demand-side incentives were reported including expansion of ATLS to non-physician cadre credentialing and use of subsidies.
Conclusion
ATLS region chiefs and country directors reported a variety of demand-side incentives that may facilitate the promulgation of ATLS. Actionable steps include: (i) shift incentivization from ATLS course completion to maintenance of verification; (ii) develop an incentive toolkit of best practices to support implementation; and (iii) engage leadership stakeholders to use demand-side incentives to improve the training and capabilities of the providers they oversee to care for the injured.