Use of a Modified American College of Surgeons Trauma Quality Improvement Program to Enhance 30-Day Post-Trauma Readmission Detection

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• 作者：David S. Shapiro ; MD ; FACS ; Affan Umer ; MD ; ^{aumer@stfranciscare.org" class="auth_mail" title="E-mail the corresponding author} ; William T. Marshall ; DO ; FACOS ; Kelly Hansen ; MSN ; Ellen Boucher ; CSTR ; Alph Emmanuel ; MD ; Scott Ellner ; DO ; FACS ; James M. Feeney ; MD ; FACS
• 关键词：ACS TQIP ; American College of Surgeons Trauma Quality Improvement Program ; HTR ; hospital trauma registry ; MTQIP ; ACS NSQIP quality assessment and improvement tool modified for ACS TQIP ; QAI ; quality assessment and improvement
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：222
• 期：5
• 页码：865-869
• 全文大小：183 K

文摘

Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide. We use ACS TQIP, which does not include 30-day outcomes featured in the ACS NSQIP, affecting observed readmission rates.

Study Design

Trauma patients were subjected to the 30-day follow-up with the ACS NSQIP tools to assess readmission rates. The existing standard hospital and trauma registry data review was used to determine readmission, with the same group assessed for readmission using the information collected with the modified TQIP tools. All data collected via this method were patient reported and verified by review of records at our facility and via patient-authorized outside record review.

Results

Six hundred and ninety-eight consecutive patients were admitted to the trauma service during the study period and 378 (54.1%) were contacted by telephone for interview. Demographic characteristics were similar (p = NS). The readmission rate changed from 4.01% to 2.4% using the hospital and trauma registry subset (p = NS). Readmission rate by the modified TQIP method was 7.1% (p < 0.03). Readmitted patients did not differ with respect to routine follow-up visits.

Conclusions

We hypothesized that our observed and actual readmission rates differed. We discovered a significant difference in reported rates. Incorporating an NSQIP-like postdischarge feedback process can improve the accuracy of hospitals' readmission data and complication reporting, and thereby improve the value of the information TQIP uses as benchmarks.