The impact of teaching status on trauma center clinical outcomes in the United States

Abstract

Teaching status/academic ranking may play a role in the variations in trauma center (TC) outcomes. Our study aimed to determine the relationship between TC teaching status and injury-adjusted, all-cause mortality in a national sampling. Retrospective review of the National Sample Program (NSP) from the National Trauma Data bank (NTDB). TCs were categorized based on teaching status. Adjusted mortality was determined by observed/expected (O/E) mortality ratios, derived using TRauma Injury Severity Score methodology from the Injury Severity Score and Revised Trauma Score. Chi-square and t test analyses were utilized with a statistical significance defined as P <.05. Of the 94 TCs in the NSP, 46 were university, 38 were community teaching, and 10 were community nonteaching. For the University TCs, 62.8% were American College of Surgeons (ACS) level 1 and 81.2% state level 1. Of the community teaching TCs, 39.0% was ACS level 1 and 35.1% was state level 1. Of the community nonteaching TCs, 0% was ACS level 1 and 11.1% was state level 1. University TCs had a significantly higher O/E mortality rate than community teaching (0.75 vs 0.71; P = .04). There were no differences in O/E between community teaching and nonteaching TCs (0.71 vs 0.70; P = .70). Community teaching and nonteaching TCs have lower injury-adjusted, all-cause mortality rates than University Centers. Future studies should further investigate key differences between University TCs and community teaching TC to evaluate possible quality and performance improvement measures.

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

“…acute care rehabilitation). However, Harda, Chun, and Chiu estimated that patients in disproportionate share hospitals were less likely to receive acute care physical therapy after hip fracture treatments relative to patients receiving care in non-disproportionate share hospitals [44]; a result that supports the concept that the treatment patients receive and their subsequent health outcomes may differ on components beyond demographic characteristics, such as hospital based-factors [16,17,24,25]. Other patient-based variables, such as health insurance type, were also associated with LOS both within and between hospital categories.…”

“…These outcomes, however, are not homogenous across the population; researchers have identified differences in hip fracture treatment outcomes among racial and socioeconomic groups [12]. Disparities between groups on health care outcomes may arise from patientlevel factors [13,14] as well as from where patients receive treatment [15][16][17] and their health insurance status [13,14,18]. The primary objective of this study was to examine whether hip fracture treatment outcomes differed between patients who received care at safety-net hospitals (e.g., hospitals with a payer mix consisting of a large share of Medicaid and uninsured patients) and patients who received care at non-safety-net hospitals.…”

“…In addition to other hospital types [16,17], researchers found outcome differences between patients treated at SNH and those treated at NSNH [8,[25][26][27][28]. Furthermore, Kumar et al [29] estimated that hip fracture patient outcomes differed within a skilled nursing facility based upon patients' health insurance types.…”

American College of Surgeons Committee on Trauma Verification Level II vs. Level I Outcomes: Similar but Without all the Hype

“…Using their suggested statistical methods, this group showed superior O/E mortality at community teaching and non-teaching hospitals vs university centers in their previous work. 7 The letter writers go on to address the Orange Book. It is obvious that there may be varied performance at Level II centers just as there is variation in at Level I centers.…”

“…Using their suggested statistical methods, this group showed superior O/E mortality at community teaching and non-teaching hospitals vs university centers in their previous work. 7…”