Centers for Medicare and Medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma centers.
OBJECTIVE
The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital compliance with evidence-based processes of care as quality indicators. We hypothesized that compliance with CMS quality indicators would correlate with risk-adjusted mortality rates in trauma patients.


METHODS
A previously validated risk-adjustment algorithm was used to measure observed-to-expected mortality ratios (O/E with 95% confidence interval) for Level I and II trauma centers using the National Trauma Data Bank data. Adult patients (>or=16 years) with at least one severe injury (Abbreviated Injury Score >or=3) were included (127,819 patients). Compliance with CMS quality indicators in four domains was obtained from Hospital Compare website: acute myocardial infarction (8 processes), congestive heart failure (4 processes), pneumonia (7 processes), surgical infections (3 processes). For each domain, a single composite score was calculated for each hospital. The relationship between O/E ratios and CMS quality indicators was explored using nonparametric tests.


RESULTS
There was no relationship between compliance with CMS quality indicators and risk-adjusted outcomes of trauma patients.


CONCLUSIONS
CMS quality indicators do not correlate with risk-adjusted mortality rates in trauma patients. Hence, there is a need to develop new trauma-specific process of care quality indicators to evaluate and improve quality of care in trauma centers.
Shafi
Shahid
S
Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA. shahid.shafi@baylorhealth.edu
Parks
Jennifer
J
Ahn
Chul
C
Gentilello
Larry M
LM
Nathens
Avery B
AB
Hemmila
Mark R
MR
Pasquale
Michael D
MD
Meredith
J Wayne
JW
Cryer
H Gill
HG
Goble
Sandra
S
Neil
Melanie
M
Price
Chrystal
C
Fildes
John J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014487:Centers for Medicare and Medicaid Services, U.S.; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D018709:Statistics, Nonparametric; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*