Article

Centers for Medicare and Medicaid Services Quality Indicators Do Not Correlate With Risk-Adjusted Mortality at Trauma Centers

Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA.
The Journal of trauma (Impact Factor: 2.96). 04/2010; 68(4):771-7. DOI: 10.1097/TA.0b013e3181d03a20
Source: PubMed

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

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