Are Trauma Care Quality Indicators Linked to Clinical Outcomes? Yes And No

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Academic Journal
Main Category: Palliative Care / Hospice Care
Article Date: 05 Jan 2012 - 9:00 PST

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There is a clear link between several quality indicators developed by the American College of Surgeons Committee on Trauma and clinical outcomes, a new study published in JAMA revealed.

In the U.S., traumatic injuries are the fifth most prevalent cause of death, and the leading cause of death in individuals younger than 45 years. Because of the higher death rates, illness, and expenses of caring for individuals with traumatic injuries, enhancing the care of these patients is a crucial national priority. Based on expert consensus to measure loyalty to best practices and aid quality measurement, the American College of Surgeons Committee on Trauma (ACSCOT) has developed a collection of quality indicators.

In order to analyze the connection between ACSCOT quality indicators and in-hospital mortality and death or severe complications, Laurent G. Glance, M.D., of the University of Rochester School of Medicine, Rochester, N.Y., and colleagues carried out a cross-sectional investigation. The team examined data on 210,942 individuals hospitalized between 2000 and 2009 in 33 trauma centers in Pennsylvania.

The researchers explain:

"Seven of the ACSCOT quality indicators were associated with either increased (1) in-hospital mortality or (2) death or major complications."

Some of the quality indicators showed that the clinical impact seemed to be extremely strong. The researchers say:

"For example, trauma patients with an admission GCS [Glasgow Coma Scale] score less than 12 who did not receive a head CT [computed tomography] scan had a four-fold increased risk of mortality and nearly three-fold higher risk of death or major complications. Similarly, patients admitted with a gunshot wound to the abdomen that were managed non-operatively experienced a five-fold higher odds of mortality compared with those undergoing surgery."

Although, in complex patients with multiple injuries, results from the investigation indicate that some measures might lack face validity for identifying poor quality care.

The researchers conclude:

"The next version of ACSCOT process measures should be based on the best available evidence and should be carefully validated before accepting them as the basis for trauma center evaluation and quality improvement. Because of the complexity of trauma care, the goal of creating evidence-based and clinically valid process measures is likely to prove very challenging."

In an invited comment, Charles D. Mabry, M.D., of the University of Arkansas for Medical Sciences, Pine Bluff, Ark., explains that the quality improvement world is moving away from process measures toward outcomes measures.

Mabry explains:

"The current ACSCOT quality indicators (and even some trauma center verification standards) are mostly process measures, developed from a consensus process.

In the final analysis, patients, for the most part, really do not care what processes we do or do not do to them; they only care about how well they do under our care."

Dr. Mabry states that good process tolls do not necessarily make good quality measures. He says:

"While good and innovative in their day, these process audit filters and standards belong to the history of trauma care. It is now time for us to turn the page and go on to write new chapters."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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