Effectiveness of nonpublic report cards for reducing trauma mortality.

Glance LG1, Osler TM2, Mukamel DB3, Meredith JW4, Dick AW5.

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Abstract

IMPORTANCE:

An Institute of Medicine report on patient safety that cited medical errors as the 8th leading cause of death fueled demand to use quality measurement as a catalyst for improving health care quality.

OBJECTIVE:

To determine whether providing hospitals with benchmarking information on their risk-adjusted trauma mortality outcomes will decrease mortality in trauma patients.

DESIGN, SETTING, AND PARTICIPANTS:

Hospitals were provided confidential reports of their trauma risk-adjusted mortality rates using data from the National Trauma Data Bank. Regression discontinuity modeling was used to examine the impact of nonpublic reporting on in-hospital mortality in a cohort of 326206 trauma patients admitted to 44 hospitals, controlling for injury severity, patient case mix, hospital effects, and preexisting time trends.

MAIN OUTCOMES AND MEASURES:

In-hospital mortality rates. RESULTS Performance benchmarking was not significantly associated with lower in-hospital mortality (adjusted odds ratio [AOR], 0.89; 95% CI, 0.68-1.16; P=.39). Similar results were obtained in secondary analyses after stratifying patients by mechanism of trauma: blunt trauma (AOR, 0.91; 95% CI, 0.69-1.20; P=.51) and penetrating trauma (AOR, 0.75; 95% CI, 0.44-1.28; P=.29). We also did not find a significant association between nonpublic reporting and in-hospital mortality in either low-risk (AOR, 0.84; 95% CI, 0.57-1.25; P=.40) or high-risk (AOR, 0.88; 95% CI, 0.67-1.17; P=.38) patients. CONCLUSIONS AND RELEVANCE Nonpublic reporting of hospital risk-adjusted mortality rates does not lead to improved trauma mortality outcomes. The findings of this study may prove useful to the American College of Surgeons as it moves ahead to further develop and expand its national trauma benchmarking program.