title: Moving from "optimal resources" to "optimal care" at trauma centers.
abstract: BACKGROUND
  The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality.
  
  
  METHODS
  Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity.
  
  
  RESULTS
  Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality.
  
  
  CONCLUSIONS
  Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas, USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Nadine
authors.initials: N
authors.lastname: Rayan
authors.forename: Sunni
authors.initials: S
authors.lastname: Barnes
authors.forename: Neil
authors.initials: N
authors.lastname: Fleming
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: David
authors.initials: D
authors.lastname: Ballard
mesh_terms: D000328:Adult; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy