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Collecting data on organizational structures of trauma centers: the CAFE web service
  1. Mathias Brochhausen1,
  2. Jane W Ball2,
  3. Nels D Sanddal3,
  4. Jimm Dodd2,
  5. Naomi Braun1,
  6. Sarah Bost1,
  7. Joseph Utecht4,
  8. Robert J Winchell5,
  9. Kevin W Sexton6
  1. 1Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
  2. 2American College of Surgeons, Chicago, Illinois, USA
  3. 3systEMS, Bozeman, Montana, USA
  4. 4Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  5. 5Surgery, Weill Cornell Medical College, New York, New York, USA
  6. 6Surgery, UAMS, Little Rock, Arkansas, USA
  1. Correspondence to Dr Mathias Brochhausen; mbrochhausen{at}


Background During the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project.

Methods Our first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data.

Results In collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions.

Discussion The data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.

  • United States
  • delivery of health care
  • health care economics and organizations
  • surveys and questionnaires

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  • Contributors As PI of the CAFE project MB created the outline of the CAFE system and planned and supervised its implementation and assessment. He is the curator of the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT) and the main author of the current article. JB and NDS were key contributors to the development of the CAFE system and its implementation and contributed to the research and writing of the background section of this article. JD led the CAFE-related research at the American College of Surgeons Committee on Trauma. He supervised the initial data collection for the CAFE system at the ACS. NB provided technical support in transferring the CAFE code from the University of Arkansas for Medical Sciences to the University of Florida. In this capacity she made modifications to the CAFE code and environment. SB is responsible for CAFE reporting and contributed by analyzing and presenting the research process during the years. She also provided copyediting for the current publication. JU is the key software developer who developed the CAFE system in collaboration with MB. He also conducted the assessment of the OOSTT definitions by subject matter experts. RJW provided input from his experience as a trauma surgeon and ACS-COT official during all aspects of planning, implementation, and evaluation of the CAFE system. KWS provided insight on aspects of implementation, evaluation and future use of the ACS system. All authors contributed to the writing of the article and reviewed its content.

  • Funding The research presented in this article is funded by the National Institute of General Medical Sciences of the National Institutes of Health under award number R01GM111324.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This research was deemed exempt by the University of Florida Institutional Review Board per IRB201902564.

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

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