Comparative Effectiveness of Clinical Care Processes in Resuscitation and Management of Moderate to Severe Traumatic Injuries
Principal Investigator: Shahid Shafi, MPH, MD, FACS
Lead Institution: Baylor Research Institute
Participating Centers: University of Texas Health Science Center, Houston, University of California at Los Angeles, Massachusetts General Hospital
Injured patients treated at designated trauma centers are more likely to survive than patients treated at non-designated hospitals. However, risk-adjusted mortality rates are highly variable across trauma centers despite availability of similar resources. If trauma centers have similar resource, variable patient outcomes are may be related to variations in clinical care processes. The hypothesis for this study was that clinical care processes for trauma patients vary across centers, and specific processes that improve patient outcomes can be identified. Also, it was hypothesized that processes that increase costs without improving outcomes can be determined. This was a multicenter retrospective study of four Level I trauma centers. Adult patients with moderate to severe injuries were included. Clinical care processes related to initial assessment, resuscitation, hemorrhage control, operative care, critical care, and rehabilitation, as well as patient outcomes were measured. Compliance with 22 trauma-specific Processes of Care (T-POC) was also measured. The association between T-POC compliance and patient outcomes was measured. The study found that compliance was highest for T-POC involving resuscitation and was lowest for neurosurgical interventions. Across trauma centers, compliance with recommended T-POC was suboptimal (with significant variations in clinical practices). Improved adoption of recommended care may reduce mortality but will likely increase costs and complications.
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Rayan N, Barnes S. Fleming N, Kudyakov R, Ballard D, Gentilello LM, Shafi S. Barriers to compliance with evidence-based care in trauma. J Trauma. 2012;72(3): 585-593.