Moving from 'optimal resources' to 'optimal care' at trauma centers
| Autor: | Larry M. Gentilello, Sunni A. Barnes, Neil S. Fleming, Shahid Shafi, David J. Ballard, Nadine Rayan |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Wounds Nonpenetrating Critical Care and Intensive Care Medicine Injury Severity Score Trauma Centers Health care medicine Humans Hospital Mortality Quality Indicators Health Care Quality of Health Care Retrospective Studies Abbreviated Injury Scale business.industry Mortality rate Process Assessment Health Care Trauma center Retrospective cohort study Trauma quality improvement program Middle Aged Quality Improvement Practice Guidelines as Topic Emergency medicine Wounds and Injuries Surgery Guideline Adherence business Medicaid |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 72:870-877 |
| ISSN: | 0022-5282 |
| DOI: | 10.1097/ta.0b013e3182463e20 |
| Popis: | Background The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. Methods Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity. Results Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality. Conclusion Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures. |
| Databáze: | OpenAIRE |
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