The ED.TRAUMA Study: Evaluating the Discordance ofTrauma Readmission And Unanticipated Mortality in the Assessment of hospital quality

项目摘要/摘要 创伤是一种常见的、高风险和高成本的疾病，它独特地影响老年人的健康。2017年 仅在美国，≥65岁的老年人中就有480万人报告了非致命性创伤伤害 各州(美国)，医院和支付者的成本超过668亿美元(2019年美元)，占美国在以下方面的总支出的2% 医疗保健。到2050年，老年人口预计将增至百万(占美国总人口的22.1% 人口)。预计随之而来的是老年创伤患者数量的平行增加。 创伤性脑损伤(TBI)和髋部骨折是最常见和最使人衰弱的创伤形式 在老年人中遇到，通常导致长期的功能障碍，疗养院入院， 独立性降低，预期寿命缩短。改善老年创伤患者的预后， 尤其是那些患有严重颅脑损伤和髋部骨折的人，是国家的重要优先事项。 虽然外部基准已演变为用于比较医院结果的卓越方法 在衡量护理质量时，它在创伤患者中的应用目前由于缺乏可用的数据而受到限制 出院后数据和创伤社区内对应用不佳的指标可能不是 代表创伤提供者治疗的复杂患者和不良后果的广度 创伤患者面对。通过这笔赠款及其三个具体目标，我们建议在现有努力的基础上，在 创伤到基准医院。在目前仅限于住院死亡率的数据基础上，我们将利用 纵向100%医疗保险服务收费声称研究老年人出院后的结果 住院原因：1)全身创伤，2)严重颅脑损伤，3)髋部骨折。目标1.量化可变性的程度 创伤死亡率和再入院表现之间的内在和潜在的不一致性。目标2.目标 确定是否存在高度相似和/或高度不同的创伤再入院医院群 和死亡率结果，并确定相关因素。目的3.比较常规外固定术的效果 与考虑竞争风险的模型下达到的再入院基准进行比较。 这项工作的发现将为创伤质量的持续发展奠定基础 可以建立改进和国家卫生政策标杆。它将对世界经济如何产生重大、直接的影响 对老年人的护理质量进行衡量和概念化，有助于确定临床护理的未来 影响老年人健康的最常见、高风险和高成本的疾病之一，而 同时通知开发有意义的强质量指标模型，并应用于 包括创伤和其他非创伤情况。

PROJECT SUMMARY/ABSTRACT Trauma is a common, high-risk, and high-cost condition that uniquely affects the health of older adults. In 2017 alone, 4.8 million non-fatal traumatic injuries were reported among older adults aged ≥65 years in the United States (US), costing hospitals and payers upwards of $66.8 billion (2019 USD) or ~2% of all US spending on healthcare. By 2050, the number of older adults is projected to rise to 89 million (22.1% of the total US population). With it is expected to come a parallel increase in the number of older adult trauma patients. Traumatic brain injury (TBI) and hip fracture are among the most common and debilitating forms of trauma encountered among older adults, often resulting in long-term functional impairments, nursing home admission, decreased independence, and shortened life expectancy. Improving outcomes for older trauma patients, particularly those with severe TBI and hip fracture, is an important national priority. While external benchmarking has evolved as the preeminent methodology used to compare hospital outcomes when measuring quality of care, its application among trauma patients is currently limited by a lack of available post-discharge data and concerns within the trauma community that poorly applied metrics might not be representative of the complex patients that trauma providers treat and the breadth of adverse outcomes that trauma patients face. Through this grant and its three specific aims, we propose to build on existing efforts within trauma to benchmark hospitals. Expanding on data currently limited to in-hospital mortality, we will utilize longitudinal 100% Medicare fee-for-service claims to study post-discharge outcomes among older adults hospitalized for: 1) trauma in general, 2) severe TBI, and 3) hip fracture. Aim 1. To quantify the extent of variability in and potential discordance between trauma mortality and readmission performance profiles. Aim 2. To ascertain whether there are clusters of hospitals with highly similar and/or highly divergent trauma readmission and mortality outcomes and identify associated factors. Aim 3. To compare the results of conventional external benchmarking for readmission with those attained under a model that allows for competing risk. The findings from this work will lay a foundation on which the continued development of trauma quality improvement and national health policy benchmarking can build. It will have a major, direct impact on how the quality of care for older adults is measured and conceptualized, helping to determine the future of clinical care for one of the most common, high-risk, and high-cost conditions affecting the health of older adults while simultaneously informing the development of meaningful and strong quality metric models with applications to both trauma and other non-trauma conditions.