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Effectiveness of Nonpublic Report Cards for Reducing Trauma Mortality

Effectiveness of Nonpublic Report Cards for Reducing Trauma Mortality ImportanceAn Institute of Medicine report on patient safety that cited medical errors as the 8th leading cause of death fueled demand to use quality measurement as a catalyst for improving health care quality. ObjectiveTo determine whether providing hospitals with benchmarking information on their risk-adjusted trauma mortality outcomes will decrease mortality in trauma patients. Design, Setting, and ParticipantsHospitals were provided confidential reports of their trauma risk–adjusted mortality rates using data from the National Trauma Data Bank. Regression discontinuity modeling was used to examine the impact of nonpublic reporting on in-hospital mortality in a cohort of 326 206 trauma patients admitted to 44 hospitals, controlling for injury severity, patient case mix, hospital effects, and preexisting time trends. Main Outcomes and MeasuresIn-hospital mortality rates. ResultsPerformance benchmarking was not significantly associated with lower in-hospital mortality (adjusted odds ratio [AOR], 0.89; 95% CI, 0.68-1.16; P = .39). Similar results were obtained in secondary analyses after stratifying patients by mechanism of trauma: blunt trauma (AOR, 0.91; 95% CI, 0.69-1.20; P = .51) and penetrating trauma (AOR, 0.75; 95% CI, 0.44-1.28; P = .29). We also did not find a significant association between nonpublic reporting and in-hospital mortality in either low-risk (AOR, 0.84; 95% CI, 0.57-1.25; P = .40) or high-risk (AOR, 0.88; 95% CI, 0.67-1.17; P = .38) patients. Conclusions and RelevanceNonpublic reporting of hospital risk-adjusted mortality rates does not lead to improved trauma mortality outcomes. The findings of this study may prove useful to the American College of Surgeons as it moves ahead to further develop and expand its national trauma benchmarking program. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Effectiveness of Nonpublic Report Cards for Reducing Trauma Mortality

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Publisher
American Medical Association
Copyright
Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/jamasurg.2013.3977
pmid
24336907
Publisher site
See Article on Publisher Site

Abstract

ImportanceAn Institute of Medicine report on patient safety that cited medical errors as the 8th leading cause of death fueled demand to use quality measurement as a catalyst for improving health care quality. ObjectiveTo determine whether providing hospitals with benchmarking information on their risk-adjusted trauma mortality outcomes will decrease mortality in trauma patients. Design, Setting, and ParticipantsHospitals were provided confidential reports of their trauma risk–adjusted mortality rates using data from the National Trauma Data Bank. Regression discontinuity modeling was used to examine the impact of nonpublic reporting on in-hospital mortality in a cohort of 326 206 trauma patients admitted to 44 hospitals, controlling for injury severity, patient case mix, hospital effects, and preexisting time trends. Main Outcomes and MeasuresIn-hospital mortality rates. ResultsPerformance benchmarking was not significantly associated with lower in-hospital mortality (adjusted odds ratio [AOR], 0.89; 95% CI, 0.68-1.16; P = .39). Similar results were obtained in secondary analyses after stratifying patients by mechanism of trauma: blunt trauma (AOR, 0.91; 95% CI, 0.69-1.20; P = .51) and penetrating trauma (AOR, 0.75; 95% CI, 0.44-1.28; P = .29). We also did not find a significant association between nonpublic reporting and in-hospital mortality in either low-risk (AOR, 0.84; 95% CI, 0.57-1.25; P = .40) or high-risk (AOR, 0.88; 95% CI, 0.67-1.17; P = .38) patients. Conclusions and RelevanceNonpublic reporting of hospital risk-adjusted mortality rates does not lead to improved trauma mortality outcomes. The findings of this study may prove useful to the American College of Surgeons as it moves ahead to further develop and expand its national trauma benchmarking program.

Journal

JAMA SurgeryAmerican Medical Association

Published: Feb 1, 2014

References

  • Multiple imputation of missing blood pressure covariates in survival analysis.
    van Buuren, S; Boshuizen, HC; Knook, DL
  • Comparing risk-adjustment methods for provider profiling.
    DeLong, ER; Peterson, ED; DeLong, DM; Muhlbaier, LH; Hackett, S; Mark, DB
  • The NSQIP: a new frontier in surgery.
    Khuri, SF
  • Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost.
    Ryan, AM
  • The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma.
    Shafi, S; Nathens, AB; Cryer, HG

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