Improving Trauma Outcomes Using Hospital Performance Reports

描述（由申请人提供）：创伤仍然是全球死亡的主要原因之一，占65岁之前所有生产性生活年数的近三分之一，超过心脏病，癌症和中风的总和。1989年，美国外科医生学会（ACS）建立了国家创伤数据库（NTDB）作为国家创伤登记处。尽管NTDB包括来自美国70%的I级创伤中心的150万患者的结局数据，但没有国家或地区努力使用这些结局数据来改善结局。具体来说，没有医院的报告卡已经制定了衡量创伤护理的质量在个别中心。此外，虽然创伤和损伤严重度评分（TRISS）方法是衡量创伤表现的金标准，但它不再准确。由于TRISS是使用MTOS数据开发的，现在已经超过20年了，创伤结局随着时间的推移而改善，TRISS方法现在过度预测死亡率。在医院一级，TRISS预测的死亡率过高，给人一种误导的印象，认为医院的表现比实际情况要好。这严重限制了TRISS在基准和质量改进方面的用途。拟议项目的目标是使用NTDB作为死亡率和功能结局风险调整模型的开发平台，并评估向创伤医院提供风险调整结局信息的影响。待检验的主要假设是，向创伤医院提供关于其风险调整结果的信息将导致改善的结果。创伤医院将随机接受或不接受关于其比较性能的反馈，并将分析向医院提供基准信息的效果。拟议的工作还将确定通过调查高绩效医院确定的“最佳实践”是否与控制患者风险和医院质量后的改善结果有关。从该项目中获得的知识将为制定旨在通过建立基于全国人口的创伤报告卡来提高创伤护理质量的政策提供信息。这样的国家创伤报告卡可以作为改善创伤患者短期和长期结果的催化剂。

DESCRIPTION (PROVIDED BY APPLICANT): Trauma remains one of the leading causes of mortality worldwide and is responsible for nearly one-third of "all lost years of productive life before age 65, exceeding losses from heart disease, cancer, and stroke combined (2)." In 1989, the American College of Surgeons (ACS) established the National Trauma Databank (NTDB) as a national trauma registry. In spite of the fact that the NTDB includes outcomes data on 1.5 million patients from 70% of Level I trauma centers in the United States, there are no national or regional efforts to use this outcomes data to improve outcomes. Specifically, no hospital report card has been developed to measure the quality of trauma care at individual centers. Furthermore, although the Trauma and Injury Severity Scoring (TRISS) methodology is the gold standard for measuring trauma performance, it is no longer accurate. Since TRISS was developed using MTOS data that is now over 20 years old and trauma outcomes have improved over time, the TRISS methodology now over-predicts mortality. At the hospital level, TRISS predicts mortality rates that are too high, giving the misleading impression that hospital performance is better than it actually is. This severely limits the usefulness of TRISS for the purpose of benchmarking and quality improvement. The goal of the proposed project is to use the NTDB as a platform for the development of mortality and functional outcome risk adjustment models, and to evaluate the impact of providing trauma hospitals with information on their risk adjusted outcomes. The primary hypothesis to be tested is that providing trauma hospitals with information on their risk-adjusted outcomes will lead to improved outcomes. Trauma hospitals will be randomized to either receive or not to receive feedback on their comparative performance, and the effect of providing hospitals with benchmarking information will be analyzed. The proposed work will also determine whether "best practices" identified by surveying high-performance hospitals are associated with improved outcomes after controlling for patient risk and hospital quality. The knowledge gained from this project will inform the development of policies designed to improve the quality of trauma care through the establishment of a national population-based Trauma Report Card. Such a National Trauma Report Card could serve as a catalyst for improving short and long-term outcomes for trauma patients.