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Original Investigation |

Effectiveness of Nonpublic Report Cards for Reducing Trauma Mortality

Laurent G. Glance, MD1; Turner M. Osler, MD2; Dana B. Mukamel, PhD3; J. Wayne Meredith, MD4; Andrew W. Dick, PhD5
[+] Author Affiliations
1Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York
2Department of Surgery, University of Vermont Medical College, Colchester
3Center for Health Policy Research, Department of Medicine, University of California, Irvine
4Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
5RAND, RAND Health, Boston, Massachusetts
JAMA Surg. 2014;149(2):137-143. doi:10.1001/jamasurg.2013.3977.
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Importance  An Institute of Medicine report on patient safety that cited medical errors as the 8th leading cause of death fueled demand to use quality measurement as a catalyst for improving health care quality.

Objective  To determine whether providing hospitals with benchmarking information on their risk-adjusted trauma mortality outcomes will decrease mortality in trauma patients.

Design, Setting, and Participants  Hospitals were provided confidential reports of their trauma risk–adjusted mortality rates using data from the National Trauma Data Bank. Regression discontinuity modeling was used to examine the impact of nonpublic reporting on in-hospital mortality in a cohort of 326 206 trauma patients admitted to 44 hospitals, controlling for injury severity, patient case mix, hospital effects, and preexisting time trends.

Main Outcomes and Measures  In-hospital mortality rates.

Results  Performance benchmarking was not significantly associated with lower in-hospital mortality (adjusted odds ratio [AOR], 0.89; 95% CI, 0.68-1.16; P = .39). Similar results were obtained in secondary analyses after stratifying patients by mechanism of trauma: blunt trauma (AOR, 0.91; 95% CI, 0.69-1.20; P = .51) and penetrating trauma (AOR, 0.75; 95% CI, 0.44-1.28; P = .29). We also did not find a significant association between nonpublic reporting and in-hospital mortality in either low-risk (AOR, 0.84; 95% CI, 0.57-1.25; P = .40) or high-risk (AOR, 0.88; 95% CI, 0.67-1.17; P = .38) patients.

Conclusions and Relevance  Nonpublic reporting of hospital risk-adjusted mortality rates does not lead to improved trauma mortality outcomes. The findings of this study may prove useful to the American College of Surgeons as it moves ahead to further develop and expand its national trauma benchmarking program.

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Figure 1.
Diagram Illustrating Selection of Patients Included in the Data Analysis

ICD-9 indicates International Classification of Diseases, Ninth Revision; MARC, empirical injury severities.

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Figure 2.
Trends in Adjusted Mortality Rates

The graphs show the trends in the adjusted mortality rates for all patients (A), patients with blunt or penetrating trauma (B), low-risk patients (predicted probability of death <5%) (C), high-risk patients (predicted probability of death ≥ 5%) (D), and hospitals stratified by performance strata, adjusting for patient risk factors (E). Nonpublic reporting was initiated in 2008.

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