Hazards of benchmarking complications with the National Trauma Data Bank: Numerators in search of denominators
Hazards of benchmarking complications with the National Trauma Data Bank: Numerators in search of denominators
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DOI：
10.1097/ta.0b013e31816335ae
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发表时间：
2008-02-01
影响因子：
--
通讯作者：
Cornwell, Edward E., III
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文献类型：
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作者：
Kardooni, Shahrzad;Haut, Elliott R.;Cornwell, Edward E., III
背景：创伤后并发症发生率可能是护理质量的重要指标。有意义的并发症发生率性能基准需要来自有效和可靠数据的参考标准。选择适当的分子和分母是性能改进和基准测试中数据有效性的主要考虑因素。我们检查了国家创伤数据库 (NTDB) 作为创伤中心并发症发生率基准参考的适用性。方法：我们选择了 NTDB v. 6.1 中最常报告的五种并发症（肺炎、尿路感染、急性呼吸窘迫综合征、深静脉血栓形成、心肌梗死）。我们使用由不同风险人群定义的三个不同分母来比较每种并发症的发生率。 A-来自所有 700 个报告机构的所有患者作为分母 (n=1,466,887)； B - 仅来自 441 家医院的患者报告至少一种并发症 (n=1,307,729)； C-来自医院的患者报告每种特定并发症至少发生一次，为每种并发症给出唯一的分母（n 范围=869,675 - 1,167,384）。我们还研究了并发症报告者和非报告者之间医院特征的差异。结果：当来自未报告任何并发症的机构的患者被排除在分母之外时，每种并发症的发生率增加了 12.2%。当使用每种并发症的唯一分母计算发生率时，发生率增加了 25% 至 70%。从 A 级到 C 级的变化为前五名并发症产生了新的排名顺序。直接比较时，所有并发症的 B 率和 C 率也显着不同（所有 p < 0.01）。报告并发症信息的医院每年入院人数明显更高，更有可能被指定为 I 级或 II 级创伤中心以及大学教学医院。结论：NTDB 中报告的并发症数据存在很大差异，可能会引入偏差并显着影响报告的并发症发生率。这种潜在的偏差给正确解释医院绩效基准的并发症发生率带来了挑战。我们认识到 NTDB 等大型聚合注册中心作为基准测试和性能改进目的的宝贵工具的价值。然而，我们强烈主张需要认真选择作为研究基础的分子和分母。
Background: Complication rates after trauma may serve as important indicators of quality of care. Meaningful performance benchmarks for complication rates require reference standards from valid and reliable data. Selection of appropriate numerators and denominators is a major consideration for data validity in performance improvement and benchmarking. We examined the suitability of the National Trauma Data Bank (NTDB) as a reference for benchmarking trauma center complication rates.Method: We selected the five most commonly reported complications in the NTDB v. 6.1 (pneumonia, urinary tract infection, acute respiratory distress syndrome, deep vein thrombosis, myocardial infarction). We compared rates for each complication using three different denominators defined by different populations at risk. A-all patients from all 700 reporting facilities as the denominator (n=1,466,887); B - only patients from the 441 hospitals reporting at least one complication (n=1,307,729); C-patients from hospitals reporting at least one occurrence of each specific complication, giving a unique denominator for each complication (n range=869,675 - 1,167,384). We also looked at differences in hospital characteristics between complication reporters and nonreporters.Results: There was a 12.2% increase in the rate of each complication when patients from facilities not reporting any complications were excluded from the denominator. When rates were calculated using a unique denominator for each complication, rates increased 25% to 70%. The change from rate A to rate C produced a new rank order for the top five complications. When compared directly, rates B and C were also significantly different for all complications (all p < 0.01). Hospitals that reported complication information had significantly higher annual admissions and were more likely to be designated level I or II trauma centers and be university teaching hospitals.Conclusion: There is great variability in complication data reported in the NTDB that may introduce bias and significantly influence rates of complications reported. This potential for bias creates a challenge for appropriately interpreting complication rates for hospital performance benchmarking. We recognize the value of large aggregated registries such as the NTDB as a valuable tool for benchmarking and performance improvement purposes. However, we strongly advocate the need for conscientious selection of numerators and denominators that serve as the basic foundation for research.