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Centers for Medicare and Medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma
Shahid Shafi1, Jennifer Parks, Chul Ahn
1Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA. shahid.shafi@baylorhealth.edu
Objectives:
The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital compliance with evidence-based processes of care as quality indicators. We hypothesized that compliance with CMS quality indicators would correlate with risk-adjusted mortality rates in trauma patients.
Methods:
A previously validated risk-adjustment algorithm was used to measure observed-to-expected mortality ratios (O/E with 95% confidence interval) for Level I and II trauma centers using the National Trauma Data Bank data. Adult patients (>or=16 years) with at least one severe injury (Abbreviated Injury Score >or=3) were included (127,819 patients). Compliance with CMS quality indicators in four domains was obtained from Hospital Compare website: acute myocardial infarction (8 processes), congestive heart failure (4 processes), pneumonia (7 processes), surgical infections (3 processes). For each domain, a single composite score was calculated for each hospital. The relationship between O/E ratios and CMS quality indicators was explored using nonparametric tests.
Results:
There was no relationship between compliance with CMS quality indicators and risk-adjusted outcomes of trauma patients.
Conclusions:
CMS quality indicators do not correlate with risk-adjusted mortality rates in trauma patients. Hence, there is a need to develop new trauma-specific process of care quality indicators to evaluate and improve quality of care in trauma centers.
Insights
Compliance with Centers for Medicare and Medicaid Services (CMS) quality indicators did not correlate with risk-adjusted mortality rates in trauma patients. New trauma-specific quality indicators are needed to improve care.
Area of Science:
- Trauma care quality assessment
- Healthcare policy and outcomes research
Background:
- Centers for Medicare and Medicaid Services (CMS) publicly reports hospital quality indicators.
- These indicators are based on evidence-based processes of care.
- The study investigated the correlation between these indicators and patient outcomes in trauma care.
Purpose of the Study:
- To test the hypothesis that compliance with CMS quality indicators correlates with risk-adjusted mortality rates in trauma patients.
- To evaluate the utility of current CMS quality indicators for trauma centers.
Main Methods:
- Utilized a validated risk-adjustment algorithm to calculate observed-to-expected mortality ratios (O/E) for trauma patients.
- Analyzed data from Level I and II trauma centers using the National Trauma Data Bank (127,819 adult patients with severe injuries).
- Assessed compliance with CMS quality indicators across four domains (AMI, CHF, pneumonia, surgical infections) obtained from Hospital Compare.
Main Results:
- No statistically significant relationship was found between hospital compliance with CMS quality indicators and risk-adjusted mortality outcomes in trauma patients.
- The study found no correlation between adherence to general quality measures and patient survival in severe trauma cases.
Conclusions:
- Current CMS quality indicators do not accurately reflect or predict risk-adjusted mortality rates in trauma populations.
- There is a critical need to develop novel, trauma-specific process-of-care quality indicators to effectively evaluate and enhance trauma center quality.
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