Long-term composite outcome scores may provide promising results for adult trauma centers
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Key takeaways:
- Researchers calculated composite scores, which included 27 hospital-specific quality metrics.
- Long-term composite scores may provide a better snapshot of trauma care quality compared with in-hospital mortality.
According to published results, long-term composite outcome scores may provide more promising post-discharge quality metrics compared with in-hospital mortality as the single measure for adult trauma patients.
Cheryl K. Zogg, PhD, MSPH, MHS, and colleagues used Medicare fee-for-service claims to analyze a broad array of post-discharge quality metrics from 573,554 older adults (mean age of 83.1 years) who were hospitalized for all forms of trauma, hip fracture or severe traumatic brain injury.
According to the study, researchers calculated composite outcomes scores, which included 27 reliability-adjusted, hospital-specific quality metrics. They noted 30-day and 90-day readmissions, average number of healthy days at home within 365 days, and 1-year mortality rates were the most significant drivers of composite outcome scores.
Zogg and colleagues found hospital-level factors revealed several anticipated trends in care quality when evaluated using composite scores. Longer travel time, increased rurality, decreased trauma volume and decreased percentage of patients from historically underrepresented groups were associated with worse trauma care quality when using composite scores. They noted an inverse association for trends in hospital-level factors when in-hospital mortality was used as the single measure for care quality.
“While larger trauma centers performed worse in terms of short-term mortality, better performance on longer-term mortality and post-discharge quality metrics designed to reflect successful care coordination and improved patient functional recovery speak to the utility of larger trauma centers,” the researchers wrote in the study. “The results challenge historical notions about the adequacy of in-hospital mortality as the single measure of older adult trauma quality and suggest that, when it comes to older adults, decisions about how quality is evaluated can profoundly alter understandings of what constitutes best practices for care,” they concluded.
Perspective
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Cheryl K. Zogg, PhD, MSPH, MHS, and colleagues challenge the traditional assessment of inpatient mortality as an outcome measure for trauma patients. More specifically, they argue that only looking at inpatient mortality is insufficient when assessing outcomes for older adult trauma patients. They reviewed more than 500,000 older adult trauma patients in which 27 different post-discharge metrics were combined into a single composite score. Interestingly, they found there were indeed differences in post-discharge quality metric associations with hospital-level factors when trauma quality was evaluated using composite scores vs. the usual inpatient mortality numbers. These findings make sense intuitively, and I would agree that we can’t look at inpatient mortality alone.
What is somewhat perplexing, though, are the worse outcomes at level-1 trauma centers. The authors attempt to further analyze and address this, but it is not clear why this significant difference was found. That said, the authors are to be commended on this report which will encourage many to look differently at how we measure outcomes for older adult trauma patients.
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