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Trauma quality improvement using risk-adjusted outcomes.
Shahid Shafi1, Avery B Nathens, Jennifer Parks
1Department of Surgery, Division of Burns, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, Texas, USA. shahid.shafi@utsouthwestern.edu
The Journal of Trauma
|March 12, 2008
Summary
Trauma center verification by the American College of Surgeons (ACS) doesn't guarantee optimal patient outcomes. Significant outcome variations exist among similar ACS-verified trauma centers, highlighting areas for quality improvement.
Area of Science:
- Trauma Surgery
- Healthcare Quality Improvement
- Surgical Outcomes Research
Background:
- The National Surgical Quality Improvement Program (NSQIP) tracks risk-adjusted surgical outcomes.
- The American College of Surgeons (ACS) trauma center verification focuses on resource availability, not patient outcomes.
- Hypothesis: Significant outcome variations exist among similar ACS-verified trauma centers despite comparable resources.
Purpose of the Study:
- To investigate variations in patient outcomes among American College of Surgeons (ACS)-verified Level I trauma centers.
- To determine if ACS verification, focused on resources, correlates with consistent patient survival rates.
- To identify high-performing and low-performing trauma centers based on risk-adjusted survival.
Main Methods:
- Utilized the National Trauma Data Bank (NTDB) for adult patients (16-99 years) from 58 ACS-verified Level I trauma centers (264,102 patients).
- Employed multivariate logistic regression to calculate expected survival, adjusting for patient demographics, injury mechanism, transfer status, and severity.
- Calculated Observed-to-Expected (O/E) survival ratios to categorize centers as high, low, or average performers.
Main Results:
- Nearly half of the ACS-verified Level I trauma centers demonstrated significantly different outcomes than expected based on risk adjustment.
- Fourteen centers were identified as high performers (significantly better outcomes).
- Eleven centers were identified as low performers (significantly worse outcomes), while 33 were average performers.
Conclusions:
- Current American College of Surgeons (ACS) trauma center verification may not ensure consistent optimal patient outcomes.
- Significant opportunities exist for improving trauma care quality by adopting practices from high-performing centers.
- Further validation is recommended to refine trauma center quality assessment and improvement strategies.
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