title: A retrospective cohort study of the relationship between quality indicator measurement and patient outcomes in adult trauma centers in the United States.
abstract: BACKGROUND
  Improving care is a key strategy for reducing the burden of injuries, but it is unknown whether the use of quality indicators (QI) is associated with patient outcomes. We sought to evaluate the association between the use of QIs by trauma centers and outcomes in adult injury patients.
  
  
  METHODS
  We identified consecutive adult patients (n=223,015) admitted to 233 verified trauma centers January 1, 2007 to December 31, 2010 that contributed data to the National Trauma Data Bank and participated in a survey of QI practices. Generalized Linear Mixed Models were employed to evaluate the association between the intensity (number of QIs) and nature (report cards, internal and external benchmarking) of QI use and survival to hospital discharge, adjusting for patient and hospital characteristics.
  
  
  RESULTS
  There were no significant differences in the odds of survival to trauma center discharge according to the number of QIs measured (quartiles; odds ratio{OR} [95% confidence interval{CI}] 1.00 vs. 1.08 [0.90-1.31] vs. 1.00 [0.82-1.22] vs. 1.21 [0.99-1.49]), or whether centers used reports cards (OR 1.07, 95%CI 0.94-1.23), internal (OR 1.06, 95%CI 0.89-1.26) or external (OR 1.09, 95%CI 0.92-1.31) benchmarking. The duration (geometric mean) of mechanical ventilation (4.0days), ICU stay (4.6days), hospital stay (7.7days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use.
  
  
  CONCLUSIONS
  The intensity and nature of the QIs used by trauma centers was not associated with outcomes of patient care. Alternative quality improvement strategies may be needed.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; W21C Research and Innovation Center, Institute of Public Health, University of Calgary, Calgary, Alberta, Canada. Electronic address: jamboyd@ucalgary.ca.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Boyd
authors.affiliation: Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada. Electronic address: lynne.moore@fmed.ulaval.ca.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: eatenafu@uhnresearch.ca.
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Li Ka Shing Knowledge Institute, St. Micheal's Hospital, Toronto, Canada; Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. Electronic address: jhamid@mcmaster.ca.
authors.forename: Jemila S
authors.initials: JS
authors.lastname: Hamid
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: avery.nathens@sunnybrook.ca.
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada. Electronic address: tstelfox@ucalgary.ca.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Injury; Patient outcomes; Quality indicators; Quality of care; Trauma systems