Willis Cameron D, Stoelwinder Johannes U, Lecky Fiona E, Woodford Maralyn, Jenks Tom, Bouamra Omar, Cameron Peter A
Centre for Research Excellence in Patient Safety, Melbourne, Victoria, Australia.
J Trauma. 2010 Aug;69(2):256-62. doi: 10.1097/TA.0b013e3181e5e2a3.
To investigate the association between a number of hospital level composite index methodologies developed from trauma indicators with inhospital mortality.
Data from January 2001 to December 2006 were extracted from the Victorian State Trauma Registry (Australia) and the Trauma Audit and Research Network (United Kingdom). Three composite methods were explored, including two denominator-based weight approaches and a factor analysis technique. The association between the composite measures and the count of inhospital mortality was investigated using Poisson regression models adjusting for expected deaths per hospital using the Trauma Injury Severity Score methodology.
Composite scores were calculated per hospital, per year. The composite score was entered in statistical models as a raw score, and the mortality difference across the central 50% of the composite index was ascertained. In total, 9,218 patients were included and were distributed across 14 hospitals. Composite scores demonstrated an inverse relationship with risk-adjusted inhospital mortality. From the 25th to the 75th percentile of each composite, mortality decreased by 11.99%, 13.58%, and 16.13% (p < 0.05).
Trauma composite indices demonstrate construct validity when used as measures of hospital level process and represent potentially useful methods of analyzing and reporting quality indicators.
探讨基于创伤指标制定的多种医院层面综合指数方法与住院死亡率之间的关联。
从维多利亚州创伤登记处（澳大利亚）和创伤审计与研究网络（英国）提取2001年1月至2006年12月的数据。探索了三种综合方法，包括两种基于分母的加权方法和一种因子分析技术。使用泊松回归模型研究综合指标与住院死亡人数之间的关联，并使用创伤损伤严重程度评分方法对每家医院的预期死亡人数进行调整。
每年计算每家医院的综合评分。综合评分以原始评分形式输入统计模型，并确定综合指数中间50%范围内的死亡率差异。总共纳入了9218名患者，分布在14家医院。综合评分与风险调整后的住院死亡率呈负相关。在每个综合指标的第25百分位数到第75百分位数之间，死亡率分别下降了11.99%、13.58%和16.13%（p<0.05）。
创伤综合指数在用作医院层面过程的衡量指标时显示出结构效度，是分析和报告质量指标的潜在有用方法。
