A Retrospective Cohort Study of the Relationship between Quality Indicator Measurement and Patient Outcomes in Adult Trauma Centers in the United States

• Published in: Injury 2017-01, Vol.48 (1), p.13-19
• Main Authors: Boyd, Jamie M, Moore, Lynne, Atenafu, Eshetu G, Hamid, Jemila S, Nathens, Avery, Stelfox, Henry T
• Format: Article
• Language: English
• Subjects: Adult; Aged; Canada - epidemiology; Female; Health Care Surveys; Humans; Injury; Injury Severity Score; Male; Middle Aged; Orthopedics; Outcome and Process Assessment (Health Care); Patient outcomes; Quality Improvement - organization & administration; Quality indicators; Quality Indicators, Health Care; Quality of care; Quality of Health Care - standards; Retrospective Studies; Trauma Centers - standards; Trauma systems; United States - epidemiology; Wounds and Injuries - mortality; Wounds and Injuries - therapy
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.10.040

Abstract Background Improving care is a key strategy for reducing the burden of injuries, but it is unknown whether the use of quality indicators (QI) is associated with patient outcomes. We sought to evaluate the association between the use of QIs by trauma centers and outcomes in adult injury patients. Methods We identified consecutive adult patients (n = 223,015) admitted to 233 verified trauma centers January 1, 2007 to December 31, 2010 that contributed data to the National Trauma Data Bank and participated in a survey of QI practices. Generalized Linear Mixed Models were employed to evaluate the association between the intensity (number of QIs) and nature (report cards, internal and external benchmarking) of QI use and survival to hospital discharge, adjusting for patient and hospital characteristics. Results There were no significant differences in the odds of survival to trauma center discharge according to the number of QIs measured (quartiles; odds ratio{OR} [95% confidence interval{CI}] 1.00 vs. 1.08 [0.90–1.31] vs. 1.00 [0.82–1.22] vs. 1.21 [0.99–1.49]), or whether centers used reports cards (OR 1.07, 95%CI 0.94–1.23), internal (OR 1.06, 95%CI 0.89–1.26) or external (OR 1.09, 95%CI 0.92–1.31) benchmarking. The duration (geometric mean) of mechanical ventilation (4.0 days), ICU stay (4.6 days), hospital stay (7.7 days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use. Conclusions The intensity and nature of the QIs used by trauma centers was not associated with outcomes of patient care. Alternative quality improvement strategies may be needed.