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

Shafi, Shahid MD, MPH; Parks, Jennifer MPH; Ahn, Chul PhD; Gentilello, Larry M. MD; Nathens, Avery B. MD, PhD; Hemmila, Mark R. MD; Pasquale, Michael D. MD; Meredith, J. Wayne MD; Cryer, H. Gill MD, PhD; Goble, Sandra PhD; Neil, Melanie MS; Price, Chrystal MS; Fildes, John J. MD

The Journal of Trauma: Injury, Infection, and Critical Care: April 2010 - Volume 68 - Issue 4 - p 771-777
doi: 10.1097/TA.0b013e3181d03a20
Original Article

Objectives: 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.

Methods: 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 (≥16 years) with at least one severe injury (Abbreviated Injury Score ≥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.

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

Conclusions: 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.

From the Department of Surgery (S.S., J.P., L.M.G.) and Clinical Sciences (C.A.), University of Texas Southwestern Medical School, Dallas, Texas; The Trauma Quality Improvement Group (TQIP) (S.S., A.B.N., M.R.H., M.D.P., J.W.M., H.G.C., S.G., M.N., C.P., J.J.F.), the American College of Surgeons, Committee on Trauma, Chicago, Illinois; University of Toronto (A.B.N.), Toronto, Ontario, Canada; University of Michigan (M.R.H.), Ann Arbor, Michigan; Lehigh Valley Hospital (M.D.P.), Lehigh, Pennsylvania; Wake Forest University (J.W.M.), Winston-Salem, North Carolina; University of California Los Angeles Medical Center (H.G.C.), Los Angeles, California; and University of Nevada (J.J.F.), Las Vegas, Nevada.

Submitted for publication December 18, 2008.

Accepted for publication December 17, 2009.

Presented at the 22nd Annual Meeting of the Eastern Association for the Surgery of Trauma, January 13–17, 2009, Lake Buena Vista, Florida.

Address for reprints: Shahid Shafi, MD, MPH, Institute for Health Care Research and Improvement, Baylor Health Care System, 1600 W. College Street, Suite LL 10, Grapevine, TX 76051; email:

© 2010 Lippincott Williams & Wilkins, Inc.