Evaluating quality indicators of tertiary care hospitals for trauma care in Japan

Objective: This study examined the associations between trauma mortality and quality of care indicators currently used in Japan. Design: This is a retrospective two-level discrete-time survival analysis. Quality indicators were derived from the 2012-2013 annual hospital survey conducted by the Ministry of Health, Labour and Welfare. Trauma mortality data were derived from the Japan Trauma Data Bank for the period of April 2012 to March 2013. Setting: Tertiary care centers designated as emergency and critical care centers (ECCCs) in Japan. Participants: The analysis included 12 378 patients aged ≥15 years with blunt trauma and an Injury Severity Score ≥9, registered to the data bank from 91 ECCCs. Intervention: Quality of care indicators examined in the annual hospital survey. Main Outcome Measures: Deaths within 30 days. Results: Of the 12 378 patients, 660 (5%) died within 30 days. Higher indicator score was significantly associated with lower mortality risk (hazard ratio [HR] for the second, third and fourth quartiles vs. lowest quartile 0.61, 0.55 and 0.52, respectively). Factors significantly associated with lower mortality risk were, higher patient volume (HR for the highest vs. lowest quartile, 0.74), director's qualification as specialist (HR 0.57) or consultant (HR 0.58), review of patient arrival process (HR 0.68), triage functions (HR 0.69), availability of psychiatrists (HR 0.75) and operating room being ready 24-h (HR 0.81). Conclusions: The study identified certain indicators associated with trauma patient mortality. Further refinement of indicators is required to specifically identify what needs changing.