The Survival Measurement and Reporting Trial for Trauma (SMARTT): background and study design.
BACKGROUND
This report describes a project funded by the Agency for Healthcare Research and Quality to evaluate the impact of providing hospitals with nonpublic report cards on trauma outcomes. The Survival Measurement and Reporting Trial for Trauma explores the feasibility of using the National Trauma Data Bank as a platform for measuring and improving trauma outcomes.


METHODS
We identified a cohort of 125 hospitals in the National Trauma Data Bank with annual hospital volumes of 250 or more trauma cases meeting specific minimum criteria for data quality. The performance of hospitals in this cohort was evaluated using hierarchical logistic regression model. The effect of each hospital on trauma mortality was captured by a shrinkage coefficient, which is exponentiated to yield an adjusted odds ratio. This adjusted odds ratio represents the likelihood that a trauma patient treated at a specific hospital is more or less likely to die compared with a patient treated at an "average" hospital.


RESULTS
The initial hospital cohort includes 125 hospitals and 157,045 patients admitted in 2006. Most hospitals are either level I (36%) or level II (34%) trauma centers. Patients admitted to the worst-performing hospitals were at least 50% more likely to die than patients admitted to the average hospital, after adjusting for injury severity.


CONCLUSIONS
The initial findings of this trial suggest that there is significant variability in trauma mortality across centers caring for injured patients after adjusting for differences in patient casemix. This variation in risk-adjusted mortality presents an opportunity for improvement. The Survival Measurement and Reporting Trial for Trauma study is designed to test the hypothesis that nonpublic report cards can lead to improved population mortality for injured patients. The results of this study may have substantial implications in the future design and implementation of a national effort to report and improve trauma outcomes in the United States.
Glance
Laurent G
LG
Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA. laurent_glance@urmc.rochester.edu
Osler
Turner M
TM
Dick
Andrew W
AW
Mukamel
Dana B
DB
Meredith
Wayne
W
D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries; D012107:Research Design; D016019:Survival Analysis; D014193:Trauma Centers / Q000592:standards*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*