A retrospective cohort study of the relationship between quality indicator measurement and patient outcomes in adult trauma centers in the United States

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• 关键词：AIS ; abbreviated injury score ; ARDS ; acute respiratory distress syndrome ; CI ; confidence interval ; DNR ; do-not-resuscitate ; ED ; emergency department ; GCS ; glasgow coma scale ; GLMM ; generalized linear mixed model ; IQR ; interquartile range ; ISS ; injury severity score ; NTDB ; National Trauma Data Bank ; OR ; odds ratio ; QI ; quality indicator ; VTE ; venous thromboembolism
• 刊名：Injury
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：48
• 期：1
• 页码：13-19
• 全文大小：494 K
• 卷排序：48

文摘

Improving care is a key strategy for reducing the burden of injuries, but it is unknown whether the use of quality indicators (QI) is associated with patient outcomes. We sought to evaluate the association between the use of QIs by trauma centers and outcomes in adult injury patients.MethodsWe identified consecutive adult patients (n = 223,015) admitted to 233 verified trauma centers January 1, 2007 to December 31, 2010 that contributed data to the National Trauma Data Bank and participated in a survey of QI practices. Generalized Linear Mixed Models were employed to evaluate the association between the intensity (number of QIs) and nature (report cards, internal and external benchmarking) of QI use and survival to hospital discharge, adjusting for patient and hospital characteristics.ResultsThere were no significant differences in the odds of survival to trauma center discharge according to the number of QIs measured (quartiles; odds ratio{OR} [95% confidence interval{CI}] 1.00 vs. 1.08 [0.90–1.31] vs. 1.00 [0.82–1.22] vs. 1.21 [0.99–1.49]), or whether centers used reports cards (OR 1.07, 95%CI 0.94–1.23), internal (OR 1.06, 95%CI 0.89–1.26) or external (OR 1.09, 95%CI 0.92–1.31) benchmarking. The duration (geometric mean) of mechanical ventilation (4.0 days), ICU stay (4.6 days), hospital stay (7.7 days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use.ConclusionsThe intensity and nature of the QIs used by trauma centers was not associated with outcomes of patient care. Alternative quality improvement strategies may be needed.