Improving Trauma Outcomes Using Hospital Performance Reports

描述(申请人提供)：创伤仍然是世界范围内死亡的主要原因之一，并导致近三分之一的“65岁以前失去的生产生活，超过心脏病、癌症和中风造成的损失的总和”(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。尽管NTDB包括来自美国70%的I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利用这些结果数据来改善结果。具体地说，还没有开发出医院成绩单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黄金标准，但它不再准确。由于TRISS是使用现在超过20年的MTOS数据开发的，而且创伤结果随着时间的推移而有所改善，TRISS方法现在高估了死亡率。在医院层面，TRISS预测的死亡率太高，给人一种误导性的印象，认为医院的表现比实际情况更好。这严重限制了TRISS在基准和质量改进方面的有用性。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。需要检验的主要假设是，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。创伤医院将被随机接受或不接受关于其相对表现的反馈，并将分析向医院提供基准信息的效果。这项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结果的改善有关。从该项目中获得的知识将有助于制定旨在通过建立基于人口的全国创伤报告卡来提高创伤护理质量的政策。这样的国家创伤报告卡可以作为催化剂，改善创伤患者的短期和长期结果。

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.