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Effect on Quality Measurement in Trauma

Laurent G. Glance, MD; Turner M. Osler, MD; Dana B. Mukamel, PhD; Wayne Meredith, MD; Andrew W. Dick, PhD

Arch Surg. 2009;144(4):326-332.

Objective  To determine the extent to which the Injury Severity Score (ISS) and Trauma Mortality Probability Model (T-MPM), a new trauma injury score based on empirical injury severity estimates, agree on hospital quality.

Design, Setting, and Patients  Retrospective cohort study based on 66 214 patients in 68 hospitals. Four risk-adjustment models based on either ISS or T-MPM were constructed, with or without physiologic information.

Main Outcome Measures  Hospital quality was measured using the ratio of the observed-to-expected mortality rates. Pairwise comparisons of hospital quality based on ISS_augmented vs T-MPM_augmented were performed using the intraclass correlation coefficient and the statistic.

Results  There was almost perfect agreement for the ratios of the observed to expected mortality rates based on the T-MPM vs the ISS when physiologic information was included in the model (intraclass correlation coefficient, 0.93). There was substantial agreement on which hospitals were identified as high-, intermediate-, and low-quality hospitals ( = 0.79). Excluding physiologic information decreased the level of agreement between the T-MPM and the ISS (intraclass correlation coefficient, 0.88 and  = 0.58).

Conclusions  The choice of expert-based or empirical Abbreviated Injury Score severity scores for individual injuries does not seem to have a significant effect on hospital quality measurement when physiologic information is included in the prediction model. This finding should help to convince all stakeholders that the quality of trauma care can be accurately measured and has face validity.

Author Affiliations: Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York (Dr Glance); Department of Surgery, University of Vermont College of Medicine, Burlington (Dr Osler); Center Health Policy Research, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Drs Mukamel and Meredith); and RAND Health, RAND Corporation, Pittsburgh, Pennsylvania (Dr Dick).

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