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Original Investigation
August 2018

Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patient Outcomes

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. 2018;153(8):747-756. doi:10.1001/jamasurg.2018.0985
Key Points

Question  How does hospital participation in a regional quality collaborative for trauma surgery affect patient outcomes over time?

Findings  In this cohort study using National Trauma Data Bank data, hospital participation in a regional collaborative quality initiative, the Michigan Trauma Quality Improvement Program, significantly improved risk-adjusted results over time. Michigan Trauma Quality Improvement Program participation was independently associated with improved outcomes for major complications and venous thromboembolism compared with nonparticipation or American College of Surgeons Trauma Quality Improvement Program participation.

Meaning  The regional collaborative quality improvement model provides the optimal framework to deliver improved patient outcomes while promoting compliance with processes of care for trauma patients.


Importance  The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma Quality Improvement Program (MTQIP) goes beyond the provision of feedback alone, focusing on collaborative quality improvement. It is unknown whether the addition of a collaborative approach to benchmark reporting improves outcomes.

Objective  To evaluate the association of hospital participation in the ACS TQIP (benchmark reporting) or the MTQIP (benchmark reporting and collaborative quality improvement) with outcomes compared with control hospitals that did not participate in either program.

Design, Setting, and Participants  In this cohort study, data from the National Trauma Data Bank from 2009 to 2015 were used. A total of 2 373 130 trauma patients 16 years or older with an Injury Severity Score of 5 or more were identified from 98 ACS TQIP hospitals, 23 MTQIP hospitals, and 429 nonparticipating hospitals, based on program participation status in 2011. A difference-in-differences analytic approach was used to evaluate whether hospital participation in the ACS TQIP or the MTQIP was associated with improved outcomes compared with nonparticipation in a quality improvement program.

Exposures  Hospital participation in MTQIP, a quality improvement collaborative, compared with ACS TQIP participation and nonparticipating hospitals.

Main Outcomes and Measures  In-hospital mortality, mortality or hospice, major complications, and venous thromboembolism events were assessed.

Results  Of the 2 373 130 included trauma patients, 64.2% were men and 73.0% were white, and the mean (SD) age was 50.7 (21.9) years. After accounting for patient factors and preexisting time trends toward improved outcomes, there was a statistically significant improvement in major complications after (vs before) hospital enrollment in the MTQIP collaborative compared with nonparticipating hospitals (odds ratio [OR], 0.89; 95% CI, 0.83-0.95) or ACS TQIP hospitals (OR, 0.88; 95% CI, 0.82-0.94). A similar result was observed for venous thromboembolism (MTQIP vs nonparticipating: OR, 0.78; 95% CI, 0.69-0.88; MTQIP vs ACS TQIP: OR, 0.84; 95% CI, 0.74-0.95), for which MTQIP targeted specific performance improvement efforts. Hospital participation in both ACS TQIP and MTQIP was associated with improvement in mortality or hospice (ACS TQIP vs nonparticipating: OR, 0.90; 95% CI, 0.87-0.93; MTQIP vs nonparticipating: OR, 0.88; 95% CI, 0.81-0.96). Hospitals participating in MTQIP achieved the lowest overall risk-adjusted mortality in the postenrollment period (4.2%; 95% CI, 4.1-4.3).

Conclusions and Relevance  This study demonstrates that hospital participation in a regional collaborative quality improvement program is associated with improved patient outcomes beyond benchmark reporting alone while promoting compliance with processes of care.

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