Background: As global emergency care grows, practical and effective performance measures are needed to ensure\nhigh quality care. Our objective was to systematically catalog and classify metrics that have been used to measure\nthe quality of emergency care in resource-limited settings.\nMethods: We searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references\nof included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was\nthen reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into\none of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered)\nand one of three of Donabedian�s structure/process/outcome categories. A fourth expert reviewer blinded to the\ninitial classifications re-classified all indicators, with a weighted kappa of 0.89.\nResults: A total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One\nhundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 %\nof metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care,\nwith few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of\ncare.\nConclusions: The published quality metrics in emergency care in resource-limited settings primarily focus on the\neffectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures\nand those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve\nquality of care and resource utilization.
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