Effectiveness of Nonpublic Report Cards for Reducing Trauma Mortality
Published in: JAMA Surgery, Volume 149, Issue 2, pages 137–143 (February 2014). doi: 10.1001/jamasurg.2013.3977
Posted on RAND.org on December 17, 2020
Read More
Access further information on this document at JAMA SurgeryThis article was published outside of RAND. The full text of the article can be found at the link above.
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 326,206 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.
This article was published outside of RAND. The full text of the article can be found at the link above.
Research conducted by
This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.