Lynne Moore1,2, Mélanie Bérubé1,2,3, Pier-Alexandre Tardif2, François Lauzier1,2,4, Alexis Turgeon1,2,4, Peter Cameron5, Howard Champion6, Natalie Yanchar7, Fiona Lecky8,9, John Kortbeek7, David Evans10, Éric Mercier2, Patrick Archambault11, François Lamontagne12, Belinda Gabbe5, Jérôme Paquet13, Tarek Razek14, Amina Belcaid15, Simon Berthelot2, Christian Malo16, Eddy Lang17, Henry Thomas Stelfox18. 1. Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada. 2. Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec City, Québec, Canada. 3. Faculty of Nursing, Université Laval, Québec City, Québec, Canada. 4. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada. 5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 6. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. 7. Department of Surgery, University of Calgary, Calgary, Alberta, Canada. 8. School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom. 9. Trauma Audit and Research Network, Salford, United Kingdom. 10. Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. 11. Population Health and Optimal Health Practices Research Unit, Transfert des Connaissances et Évaluation des Technologies et Modes d'Intervention en Santé, Centre de Recherche du CHU de Québec, Hôpital St François d'Assise, Université Laval, Québec City, Québec, Canada. 12. Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada. 13. Department of Surgery, Division of Neurosurgery, Université Laval, Québec City, Québec, Canada. 14. Department of Trauma Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Québec, Canada. 15. Institut National d'Excellence en Santé et Services Sociaux, Québec City, Québec, Canada. 16. Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada. 17. University of Calgary, Calgary, Alberta, Canada. 18. Department of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Abstract
Importance: Reducing low-value care has the potential to improve patient experiences and outcomes and free up health care resources. Sixteen quality indicators were recently developed targeting reductions in low-value trauma care based on a synthesis of the best available evidence, expert consensus, and patient preferences. Objective: To assess the validity of quality indicators on low-value trauma care using trauma registry data. Design, Setting, and Participants: Data from an inclusive Canadian provincial trauma system were used in this analysis. Included were all admissions for injury to any of the 57 provincial adult trauma centers between April 1, 2013, and March 31, 2020. Metrics for quality indicators were developed iteratively with clinical experts. Main Outcomes and Measures: Validity was assessed using a priori criteria based on 5 parameters: frequency (incidence and case volume), discrimination (interhospital variation), construct validity (correlation with quality indicators on high-value care), predictive validity (correlation with quality indicators on risk-adjusted outcomes), and forecasting (correlation over time). Results: The study sample included 136 783 patient admissions (mean [SD] age, 63 [22] years; 68 428 men [50%]). Metrics were developed for 12 of the 16 quality indicators. Six quality indicators showed moderate or high validity on all measurable parameters: initial head, cervical spine, or whole-body computed tomography for low-risk patients; posttransfer repeated computed tomography; neurosurgical consultation for mild complicated traumatic brain injury; and spine service consultation for isolated thoracolumbar process fractures. Red blood cell transfusion in low-risk patients had low frequency but had moderate or high validity on all other parameters. Five quality indicators had low validity on at least 2 parameters: repeated head CT and intensive care unit admission for mild complicated traumatic brain injury, hospital admission for minor blunt abdominal trauma, orthosis for thoracolumbar burst fractures, and surgical exploration in penetrating neck injury without hard signs. Conclusions and Relevance: This cohort study shows the feasibility of assessing low-value trauma care using routinely collected data. It provided data on quality indicators properties that can be used to decide which quality indicators are most appropriate in a given system. Results suggest that 6 quality indicators have moderate to high validity. Their implementation now needs to be tested.
Importance: Reducing low-value care has the potential to improve patient experiences and outcomes and free up health care resources. Sixteen quality indicators were recently developed targeting reductions in low-value trauma care based on a synthesis of the best available evidence, expert consensus, and patient preferences. Objective: To assess the validity of quality indicators on low-value trauma care using trauma registry data. Design, Setting, and Participants: Data from an inclusive Canadian provincial trauma system were used in this analysis. Included were all admissions for injury to any of the 57 provincial adult trauma centers between April 1, 2013, and March 31, 2020. Metrics for quality indicators were developed iteratively with clinical experts. Main Outcomes and Measures: Validity was assessed using a priori criteria based on 5 parameters: frequency (incidence and case volume), discrimination (interhospital variation), construct validity (correlation with quality indicators on high-value care), predictive validity (correlation with quality indicators on risk-adjusted outcomes), and forecasting (correlation over time). Results: The study sample included 136 783 patient admissions (mean [SD] age, 63 [22] years; 68 428 men [50%]). Metrics were developed for 12 of the 16 quality indicators. Six quality indicators showed moderate or high validity on all measurable parameters: initial head, cervical spine, or whole-body computed tomography for low-risk patients; posttransfer repeated computed tomography; neurosurgical consultation for mild complicated traumatic brain injury; and spine service consultation for isolated thoracolumbar process fractures. Red blood cell transfusion in low-risk patients had low frequency but had moderate or high validity on all other parameters. Five quality indicators had low validity on at least 2 parameters: repeated head CT and intensive care unit admission for mild complicated traumatic brain injury, hospital admission for minor blunt abdominal trauma, orthosis for thoracolumbar burst fractures, and surgical exploration in penetrating neck injury without hard signs. Conclusions and Relevance: This cohort study shows the feasibility of assessing low-value trauma care using routinely collected data. It provided data on quality indicators properties that can be used to decide which quality indicators are most appropriate in a given system. Results suggest that 6 quality indicators have moderate to high validity. Their implementation now needs to be tested.
Authors: Lynne Moore; Pier-Alexandre Tardif; François Lauzier; Melanie Bérubé; Patrick Archambault; François Lamontagne; Michael Chassé; Henry T Stelfox; Belinda Gabbe; Fiona Lecky; John Kortbeek; Paule Lessard Bonaventure; Catherine Truchon; Alexis F Turgeon Journal: J Neurotrauma Date: 2020-09-30 Impact factor: 5.269
Authors: Lynne Moore; Henry Thomas Stelfox; Alexis F Turgeon; Avery B Nathens; André Lavoie; Gilles Bourgeois; Jean Lapointe Journal: J Trauma Acute Care Surg Date: 2014-05 Impact factor: 3.313
Authors: Lynne Moore; François Lauzier; Henry T Stelfox; John Kortbeek; Richard Simons; Simon Berthelot; Julien Clément; Gilles Bourgeois; Alexis F Turgeon Journal: JAMA Surg Date: 2016-07-01 Impact factor: 14.766
Authors: Juliana de Oliveira Costa; Sallie-Anne Pearson; Adam G Elshaug; Kees van Gool; Louisa R Jorm; Michael O Falster Journal: JAMA Netw Open Date: 2021-12-01
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069
Authors: Abid D Khan; Anna J Elseth; Jacqueline A Brosius; Eliza Moskowitz; Sean C Liebscher; Michael J Anstadt; Julie A Dunn; John H McVicker; Thomas Schroeppel; Richard P Gonzalez Journal: Trauma Surg Acute Care Open Date: 2020-05-28