Hospital performance in caring for injured patients: does the type of injury make a difference?

OBJECTIVE

To determine whether quality measures based on injury-specific models provide a different perspective about relative hospital rankings compared with a single outcome measure based on all trauma patients.

DESIGN

We customized the Trauma Mortality Probability Model to create separate injury-specific models for patients who sustained blunt trauma, gunshot wounds, pedestrian trauma, or motor vehicle accident trauma.

SETTING

This analysis was conducted using the National Trauma Data Bank. We limited the study to hospitals with 250 or more trauma admissions per year, which coded more than 90% of patients.

PATIENTS

The final data set included 54 859 patients admitted to 44 hospitals.

MAIN OUTCOME MEASURES

We performed hospital-level analyses to examine the correlation between hospital risk-adjusted mortality measures based on all trauma patients vs quality measures based on injury-specific measures.

RESULTS

The analysis of the intraclass correlation coefficients suggests fair-to-substantial agreement (0.39-0.68) between the hospital-adjusted odds ratios based on all patients vs odds ratios based on specific injuries. kappa Analysis demonstrated poor-to-fair agreement between hospital categorical quality measures (high, intermediate, and low quality) when hospital quality was based on outcomes for all trauma patients vs specific subgroups of patients (0.0-0.38). However, none of the hospitals classified as high quality, based on data from all trauma patients, was found to be low quality for any specific injury populations.

CONCLUSION

A single composite measure based on all injured patients may not capture all the differences in hospital quality across different populations of injured patients.