Judging trauma center quality: does it depend on the choice of outcomes?
Judging trauma center quality: does it depend on the choice of outcomes?
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判断创伤中心的质量：是否取决于结果的选择？
DOI：
10.1097/01.ta.0000047808.77902.83
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Mukamel,Dana
中科院分区：
文献类型：
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作者：
Glance,LaurentG;Dick,Andrew;Osler,TurnerM;Mukamel,Dana
背景创伤中心通常使用TRISS方法将他们的生存结果与国家标准进行比较。然而，使用的生存作为衡量创伤护理的有效性可能是太有限的范围，因为它无法捕捉有关功能outcome.MethodsThe的目的是开发一个预测模型，使医院能够基准他们的功能结果在钝性创伤患者，并确定是否评估医院的“质量”取决于选择的结果措施：生存率或生存率与功能结局相结合。这项回顾性队列研究是基于国家创伤数据库中1999年遭受钝性创伤而无相关头部或脊髓损伤的18岁或以上患者。我们开发了一个序贯逻辑模型来预测良好功能结局的概率。根据该数据集定制TRISS方法，以获得生存模型。使用这些预测模型中的每一个，我们获得了两个标准化的医院绩效指标：一个基于幸存者的数量，另一个基于具有良好功能结果的幸存者的数量。这些标准化的结果测量，然后用来确定低性能和高性能的医院。这两个不同的措施的基础上的排名compared.Results15在研究队列中的27家医院进行了不同的分类时，他们的表现为基准生存与功能的结果。Kappa分析显示，这两个质量指标之间的协议最小的医院质量离群值的身份（κ= 0.04; p= 0.35）。结论医院质量的评价取决于医院的性能是否判断看生存或生存与功能的结果相结合。由于功能状态是幸存者主要关注的重要结果，因此将其纳入医院绩效评估非常重要。在评估创伤中心的表现时，应考虑包括功能结局。
BackgroundTrauma centers routinely benchmark their survival outcomes against a national norm using the TRISS methodology. However, the use of survival as a measure of the effectiveness of trauma care may be too limited in scope because it fails to capture information regarding functional outcomes.MethodsThe objective of this study was to develop a prediction model that allows hospitals to benchmark their functional outcomes in blunt trauma patients, and to determine whether the assessment of hospital “quality” depends on the choice of outcome measure: survival or survival combined with functional outcome. This retrospective cohort study was based on patients, aged 18 years or older, in the National Trauma Database who sustained blunt trauma in 1999 without associated head or spinal cord injury. We developed a sequential logistic model to predict the probability of a good functional outcome. The TRISS methodology was customized to this data set to obtain a survival model. Using each of these prediction models, we then obtained two standardized measures of hospital performance: one based on the number of survivors and the other based on the number of survivors with good functional outcomes. These standardized outcome measures were then used to identify low-performance and high-performance hospitals. The ranking based on these two different measures were compared.ResultsFifteen of the 27 hospitals in the study cohort were categorized differently when their performance was benchmarked using survival versus functional outcome. Kappa analysis revealed minimal agreement between these two quality measures on the identity of hospital quality outliers (κ= 0.04; p= 0.35).ConclusionThe evaluation of hospital quality depends on whether hospital performance is judged by looking at survival or at survival combined with functional outcome. Because functional status is an important outcome of major concern to survivors, it is important to include it in hospital performance assessment. Consideration should be given to including functional outcome in the evaluation of trauma center performance.