Citation

Glance LG, Mukamel DB, Meredith W, Dick AW. Arch. Surg. (1960) 2009; 144(12): 1121-1126.

Affiliation

Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York 14642, USA. laurent_glance@urmc.rochester.edu

Copyright

(Copyright © 2009, American Medical Association)

DOI

10.1001/archsurg.2009.218

PMID

20026829

Abstract

OBJECTIVE: To determine whether quality measures based on injury-specific models provide a different perspective about relative hospital rankings compared with a single outcome measure based on all trauma patients. DESIGN: We customized the Trauma Mortality Probability Model to create separate injury-specific models for patients who sustained blunt trauma, gunshot wounds, pedestrian trauma, or motor vehicle accident trauma. SETTING: This analysis was conducted using the National Trauma Data Bank. We limited the study to hospitals with 250 or more trauma admissions per year, which coded more than 90% of patients. PATIENTS: The final data set included 54 859 patients admitted to 44 hospitals. MAIN OUTCOME MEASURES: We performed hospital-level analyses to examine the correlation between hospital risk-adjusted mortality measures based on all trauma patients vs quality measures based on injury-specific measures. RESULTS: The analysis of the intraclass correlation coefficients suggests fair-to-substantial agreement (0.39-0.68) between the hospital-adjusted odds ratios based on all patients vs odds ratios based on specific injuries. kappa Analysis demonstrated poor-to-fair agreement between hospital categorical quality measures (high, intermediate, and low quality) when hospital quality was based on outcomes for all trauma patients vs specific subgroups of patients (0.0-0.38). However, none of the hospitals classified as high quality, based on data from all trauma patients, was found to be low quality for any specific injury populations. CONCLUSION: A single composite measure based on all injured patients may not capture all the differences in hospital quality across different populations of injured patients.

Language: en