Hospital Performance in Caring for Injured Patients: Does the Type of Injury Make a Difference?

OBJECTIVE: To determine whether quality measures based on injury-specific models provide a different perspective about relative hospital rankings compared with a single outcome measure based on all trauma patients. DESIGN: We customized the Trauma Mortality Probability Model to create separate injury-specific models for patients who sustained blunt trauma, gunshot wounds, pedestrian trauma, or motor vehicle accident trauma. SETTING: This analysis was conducted using the National Trauma Data Bank. We limited the study to hospitals with 250 or more trauma admissions per year, which coded more than 90% of patients. PATIENTS: The final data set included 54 859 patients admitted to 44 hospitals. MAIN OUTCOME MEASURES: We performed hospital-level analyses to examine the correlation between hospital risk-adjusted mortality measures based on all trauma patients vs quality measures based on injury-specific measures. RESULTS: The analysis of the intraclass correlation coefficients suggests fair-to-substantial agreement (0.39-0.68) between the hospital-adjusted odds ratios based on all patients vs odds ratios based on specific injuries. kappa Analysis demonstrated poor-to-fair agreement between hospital categorical quality measures (high, intermediate, and low quality) when hospital quality was based on outcomes for all trauma patients vs specific subgroups of patients (0.0-0.38). However, none of the hospitals classified as high quality, based on data from all trauma patients, was found to be low quality for any specific injury populations. CONCLUSION: A single composite measure based on all injured patients may not capture all the differences in hospital quality across different populations of injured patients. Language: en