The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma

Shafi, Shahid; Nathens, Avery B.; Cryer, H. Gill; Hemmila, Mark R.; Pasquale, Michael D.; Clark, David E.; Neal, Melanie; Goble, Sandra; Meredith, J. Wayne; Fildes, John

doi:10.1016/j.jamcollsurg.2009.07.001

Cited by 160 publications

(121 citation statements)

References 34 publications

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“…26 Reliability of the data is ensured through intensive training mechanisms for the abstractors and interrater reliability audits of the participating sites. 27 The inclusion criteria for entry into TQIP require at least one valid trauma International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code in the range of 800-959, excluding the late effects of trauma (905-909). 26 Although the ACS administers the program, the authors of this study are solely responsible for the analyses and conclusions presented here.…”

Section: Data Sourcementioning

confidence: 99%

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Alali

Fowler

Mainprize

et al. 2013

Journal of Neurotrauma

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Although existing guidelines support the utilization of intracranial pressure (ICP) monitoring in patients with traumatic brain injury (TBI), the evidence suggesting benefit is limited. To evaluate the impact on outcome, we determined the relationship between ICP monitoring and mortality in centers participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). Data on 10,628 adults with severe TBI were derived from 155 TQIP centers over 2009-2011. Random-intercept multilevel modeling was used to evaluate the association between ICP monitoring and mortality after adjusting for important confounders. We evaluated this relationship at the patient level and at the institutional level. Overall mortality (n = 3769) was 35%. Only 1874 (17.6%) patients underwent ICP monitoring, with a mortality of 32%. The adjusted odds ratio (OR) for mortality was 0.44 [95% confidence interval (CI), 0.31-0.63], when comparing patients with ICP monitoring to those without. It is plausible that patients receiving ICP monitoring were selected because of an anticipated favorable outcome. To overcome this limitation, we stratified hospitals into quartiles based on ICP monitoring utilization. Hospitals with higher rates of ICP monitoring use were associated with lower mortality: The adjusted OR of death was 0.52 (95% CI, 0.35-0.78) in the quartile of hospitals with highest use, compared to the lowest. ICP monitoring utilization rates explained only 9.9% of variation in mortality across centers. Results were comparable irrespective of the method of case-mix adjustment. In this observational study, ICP monitoring utilization was associated with lower mortality. However, variability in ICP monitoring rates contributed only modestly to variability in institutional mortality rates. Identifying other institutional practices that impact on mortality is an important area for future research.

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Section: Data Sourcementioning

confidence: 99%

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Alali

Fowler

Mainprize

et al. 2013

Journal of Neurotrauma

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181

145

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“…10 However, the way in which these guidelines are implemented varies, leading to differences in outcome across Level I and Level II centers. 33 This variation has given the committee's Trauma Quality Improvement Program an opportunity to explore differences in the processes of care that might affect outcomes. The program has implemented a system of confidential reports that are used by an increasing number of trauma centers to compare their outcomes to national mortality benchmarks.…”

Section: 3132mentioning

confidence: 99%

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

2013

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Trauma systems provide an organized approach to the care of injured patients within a defined geographic region. When fully operational, the systems ensure a continuum of care involving public access through 911 calls, emergency medical services, timely triage and transport to acute care, and transfer to rehabilitation services. Substantial progress has been made in establishing statewide trauma systems, which are seen as the prototype for regionalized care for other time-sensitive, emergency conditions such as stroke. Trauma systems provide a model of care that is consistent with the goals of the Affordable Care Act, which authorizes $100 million in annual grants to ensure the continued availability of trauma services. Full funding of these provisions is needed to stabilize statewide systems that are struggling to survive. We describe the components of a regionalized trauma system, review the evidence in support of this approach, and discuss the challenges to sustaining systems that are accountable and affordable.

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“…Conversely, "high outliers" -physicians and hospitals with wait times that were significantly longer than average -were those with lower limits of their 95% CI wait time greater than 0. 45,46 To validate the effect of individual physicians and hospitals on variability in wait times, we reran the 3-level hierarchical regression model with clinical outcomes (30-d mortality, surgical complications) and medical costs in place of wait times (Appendix 1D).All analyses were performed on linked, coded data at the Institute for Clinical Evaluative Sciences using SAS software (SAS version 9.3, SAS Institute), and we set type I error probability to 0.05. We excluded patients with missing data (< 1% for all variables considered [ Table 1]) from the regression models.…”

mentioning

confidence: 99%

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada

Pincus

Wasserstein

Ravi

et al. 2018

CMAJ

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The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma

Cited by 160 publications

References 34 publications

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To Patient Health Care Needs

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada

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