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Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II
Nam Yong Cho1, Jeff Choi2, Saad Mallick1
1From the Center for Advanced Surgical and Interventional Technology (Cho, Mallick, Machado-Aranda, Tillou, Benharash), David Geffen School of Medicine, University of California, Los Angeles, CA.
Background:
The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures.
Study Design:
We analyzed data from the 2018 to 2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTCs), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC.
Results:
During the study period, 1,498,602 patients across 442 level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure to rescue, and takeback. Additionally, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (odds ratio [OR] 1.40, 95% CI 1.29 to 1.51), appropriate pediatric admissions (OR 1.88, 95% CI 1.07 to 3.68), and substance abuse screening (OR 1.14, 95% CI 1.12 to 1.16).
Conclusions:
Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high performance, multidisciplinary efforts to refine and implement guidelines are warranted.
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