Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, CT.
Department of Surgery, Trauma and Critical Care, Saint Francis Hospital and Medical Center, Hartford, CT.
J Am Coll Surg. 2016 May;222(5):865-9. doi: 10.1016/j.jamcollsurg.2016.02.008. Epub 2016 Feb 19.
Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide. We use ACS TQIP, which does not include 30-day outcomes featured in the ACS NSQIP, affecting observed readmission rates.
Trauma patients were subjected to the 30-day follow-up with the ACS NSQIP tools to assess readmission rates. The existing standard hospital and trauma registry data review was used to determine readmission, with the same group assessed for readmission using the information collected with the modified TQIP tools. All data collected via this method were patient reported and verified by review of records at our facility and via patient-authorized outside record review.
Six hundred and ninety-eight consecutive patients were admitted to the trauma service during the study period and 378 (54.1%) were contacted by telephone for interview. Demographic characteristics were similar (p = NS). The readmission rate changed from 4.01% to 2.4% using the hospital and trauma registry subset (p = NS). Readmission rate by the modified TQIP method was 7.1% (p < 0.03). Readmitted patients did not differ with respect to routine follow-up visits.
We hypothesized that our observed and actual readmission rates differed. We discovered a significant difference in reported rates. Incorporating an NSQIP-like postdischarge feedback process can improve the accuracy of hospitals' readmission data and complication reporting, and thereby improve the value of the information TQIP uses as benchmarks.
创伤仍然是全球可预防发病率和死亡率的主要原因，经济负担巨大。每年医疗保险支出的四分之一来自再入院，包括创伤。美国外科医师学院创伤质量改进计划（ACS TQIP）已经提高了全球 200 多个创伤项目的护理水平。我们使用 ACS TQIP，但它不包括 ACS NSQIP 中包含的 30 天结果，这会影响观察到的再入院率。
使用 ACS NSQIP 工具对创伤患者进行 30 天随访，以评估再入院率。使用现有的标准医院和创伤登记数据审查来确定再入院，使用修改后的 TQIP 工具收集的信息评估同一组的再入院情况。通过这种方法收集的所有数据均由患者报告，并通过审查我们机构的记录和患者授权的外部记录审查进行验证。
在研究期间，有 698 名连续患者入住创伤科，其中 378 名（54.1%）通过电话接受采访。人口统计学特征相似（p=NS）。使用医院和创伤登记子集，再入院率从 4.01%降至 2.4%（p=NS）。使用修改后的 TQIP 方法，再入院率为 7.1%（p<0.03）。再入院患者在常规随访就诊方面没有差异。
我们假设我们观察到的和实际的再入院率不同。我们发现报告率存在显著差异。纳入类似于 NSQIP 的出院后反馈过程可以提高医院再入院数据和并发症报告的准确性，从而提高 TQIP 用作基准的信息的价值。
