Mind the gap: A call to integrate equity measures in the Trauma Quality Improvement Program

Area of Science:

• Trauma Surgery
• Health Services Research
• Health Equity

Background:

• Equity is a critical domain of healthcare quality.
• Current trauma quality improvement programs do not explicitly assess equity.
• There is a need to evaluate equitable outcomes within trauma centers for vulnerable populations.

Purpose of the Study:

• To assess equitable outcomes within hospitals for populations experiencing health disparities.
• To identify trauma centers with low, average, and high mortality rates.
• To evaluate within-hospital equity across different racial, ethnic, and insurance groups.

Main Methods:

• Retrospective analysis of 2018-2020 Trauma Quality Improvement Program (TQIP) data from Level 1/2 trauma centers.
• Used multivariable logistic regression to calculate hospital-level risk-adjusted mortality and observed vs. expected (O/E) mortality ratios.
• Conducted stratified analyses to evaluate within-hospital equity by race, ethnicity, and insurance status.

Main Results:

• Analyzed data from 384 trauma centers (892,583 patients).
• 192 hospitals (50%) were classified as low-mortality, and 170 (44.3%) as high-mortality.
• Among low-mortality centers, very few met equity criteria for Black (2.1%), Hispanic (5.2%), Medicaid (7.3%), or uninsured (3.1%) patients.

Conclusions:

• A minority of low-mortality trauma centers achieve equitable outcomes for all populations.
• Health inequities for minoritized and vulnerable groups are often masked in overall quality reports.
• Incorporating equity measures and stratified analyses into quality reports is crucial for targeted improvement initiatives.