Centers for Medicare and Medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma centers.
OBJECTIVES: The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital compliance with evidence-based processes of care as quality indicators. We hypothesized that compliance with CMS quality indicators would correlate with risk-adjusted mortality rates in trauma patients.
METHODS: A previously validated risk-adjustment algorithm was used to measure observed-to-expected mortality ratios (O/E with 95% confidence interval) for Level I and II trauma centers using the National Trauma Data Bank data. Adult patients (>or=16 years) with at least one severe injury (Abbreviated Injury Score >or=3) were included (127,819 patients). Compliance with CMS quality indicators in four domains was obtained from Hospital Compare website: acute myocardial infarction (8 processes), congestive heart failure (4 processes), pneumonia (7 processes), surgical infections (3 processes). For each domain, a single composite score was calculated for each hospital. The relationship between O/E ratios and CMS quality indicators was explored using nonparametric tests.
RESULTS: There was no relationship between compliance with CMS quality indicators and risk-adjusted outcomes of trauma patients.
CONCLUSIONS: CMS quality indicators do not correlate with risk-adjusted mortality rates in trauma patients. Hence, there is a need to develop new trauma-specific process of care quality indicators to evaluate and improve quality of care in trauma centers.
Published In/Presented At
Shafi S, Parks J, Ahn C, Gentilello LM, Nathens AB, Hemmila MR, Pasquale MD, Meredith JW, Cryer HG, Goble S, Neil M, Price C, Fildes JJ. Centers for Medicare and Medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma centers. J Trauma. 2010 Apr;68(4):771-7. doi: 10.1097/TA.0b013e3181d03a20. PMID: 20386272.
Medicine and Health Sciences
Department of Surgery