Jamie M Boyd1, Lynne Moore2, Eshetu G Atenafu3, Jemila S Hamid4, Avery Nathens5, Henry T Stelfox6. 1. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; W21C Research and Innovation Center, Institute of Public Health, University of Calgary, Calgary, Alberta, Canada. Electronic address: jamboyd@ucalgary.ca. 2. Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada. Electronic address: lynne.moore@fmed.ulaval.ca. 3. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: eatenafu@uhnresearch.ca. 4. Li Ka Shing Knowledge Institute, St. Micheal's Hospital, Toronto, Canada; Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. Electronic address: jhamid@mcmaster.ca. 5. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: avery.nathens@sunnybrook.ca. 6. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada. Electronic address: tstelfox@ucalgary.ca.
Abstract
BACKGROUND: 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. METHODS: We 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. RESULTS: There 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 (4.0days), ICU stay (4.6days), hospital stay (7.7days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use. CONCLUSIONS: The 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.
BACKGROUND: 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 injurypatients. METHODS: We 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. RESULTS: There 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 (4.0days), ICU stay (4.6days), hospital stay (7.7days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use. CONCLUSIONS: The 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.
Authors: Lynne Moore; Howard Champion; Pier-Alexandre Tardif; Brice-Lionel Kuimi; Gerard O'Reilly; Ari Leppaniemi; Peter Cameron; Cameron S Palmer; Fikri M Abu-Zidan; Belinda Gabbe; Christine Gaarder; Natalie Yanchar; Henry Thomas Stelfox; Raul Coimbra; John Kortbeek; Vanessa K Noonan; Amy Gunning; Malcolm Gordon; Monty Khajanchi; Teegwendé V Porgo; Alexis F Turgeon; Luke Leenen Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Mathias Brochhausen; Jane W Ball; Nels D Sanddal; Jimm Dodd; Naomi Braun; Sarah Bost; Joseph Utecht; Robert J Winchell; Kevin W Sexton Journal: Trauma Surg Acute Care Open Date: 2020-07-29
Authors: Jessica E van der Meij; Leo M G Geeraedts; Saskia J M Kamphuis; Nimmi Kumar; Tony Greenfield; Geoff Tweeddale; David Rosenfeld; Scott K D'Amours Journal: ANZ J Surg Date: 2019-09-09 Impact factor: 1.872