title: Attribution 2.0: whose complication is it?
abstract: BACKGROUND
  Payment models aimed at improving quality and curbing costs are being deployed, and hospitals are evaluating complications more closely. To decrease complications, hospitals must first "attribute" them to a responsible party. Our study uses a rigorous approach to attribution in the trauma population.
  
  
  METHODS
  Twelve months of complications were reviewed by a multidisciplinary panel. Physicians, patients, nursing, and the hospital were all incorporated into the model. A point system was developed for each complication. Fractional points were given when multiple parties were involved.
  
  
  RESULTS
  One hundred twenty-five complications were analyzed. Complications were attributed as follows: 30% neurosurgery, 22% trauma surgery (100% using the traditional method), 17% orthopedic surgery, 14% nursing, 9.6% plastics, 3.8% hospital, 1.6% patient, 1.4% urology, and .6% vascular.
  
  
  CONCLUSIONS
  Up to 78% of complications were incorrectly ascribed using the traditional method. Almost 20% of complications resulted from factors outside the physician's control. Before complications can be reduced, their most proximate cause must be identified. Surgeons should own these data and lead the effort to improve quality and decrease complications.
authors.affiliation: Department of Graduate Medical Education, Methodist Dallas Medical Center, 1441 N Beckley, Dallas, TX 75203, USA. Electronic address: GregHambright@MHD.com.
authors.forename: Greg
authors.initials: G
authors.lastname: Hambright
authors.affiliation: Department of Graduate Medical Education, Methodist Dallas Medical Center, 1441 N Beckley, Dallas, TX 75203, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Clinical Research Institute, Methodist Health System, Dallas, TX, USA.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Agrawal
authors.affiliation: Dallas Orthopedic Trauma Institute, Medhealth Medical Group, Dallas, TX, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arazosa
authors.affiliation: Methodist Brain and Spine Institute, Medhealth Medical Group, Dallas, TX, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Newman
authors.affiliation: Department of Graduate Medical Education, Methodist Dallas Medical Center, 1441 N Beckley, Dallas, TX 75203, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Truitt
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Attribution; Complications; Trauma