Improving Trauma Outcomes Using Hospital Performance Reports

描述（由申请人提供）：创伤仍然是世界范围内死亡的主要原因之一，在“65岁之前失去的所有有效寿命年数中，有近三分之一是由创伤造成的，超过了心脏病、癌症和中风造成的损失总和(2)。”1989年，美国外科医师学会（ACS）建立了国家创伤数据库（NTDB）作为国家创伤登记处。尽管NTDB包含了来自美国70%的一级创伤中心的150万名患者的结果数据，但没有国家或地区努力使用这些结果数据来改善结果。具体来说，没有医院报告卡来衡量个别中心的创伤护理质量。此外，尽管创伤和损伤严重程度评分（TRISS）方法是衡量创伤表现的金标准，但它不再准确。由于TRISS是使用已有20多年历史的MTOS数据开发的，而且创伤结果随着时间的推移有所改善，因此TRISS方法现在过度预测了死亡率。在医院层面，TRISS预测的死亡率过高，给人一种误导的印象，即医院的表现比实际情况要好。这严重限制了TRISS在制定基准和改进质量方面的作用。拟议项目的目标是利用NTDB作为开发死亡率和功能结果风险调整模型的平台，并评估向创伤医院提供有关其风险调整结果的信息的影响。要测试的主要假设是，向创伤医院提供有关其风险调整结果的信息将导致改善结果。创伤医院将随机接受或不接受对其比较绩效的反馈，并分析向医院提供标杆信息的效果。拟议的工作还将确定通过调查高绩效医院确定的“最佳做法”是否与控制患者风险和医院质量后的改善结果相关。从该项目中获得的知识将为制定旨在通过建立全国人口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.