Comparative Effectiveness of Clinical Care Processes in Resuscitation and Management of Moderate to Severe Traumatic Injuries
Shahid Shafi, MPH, MD, FACS

Injuries are a leading cause of death, disability, and healthcare costs. Injured patients treated at designated trauma centers are more likely to survive than patients treated at nondesignated hospitals. However, we have recently shown that some trauma centers have higher rates of mortality (i.e., preventable patient deaths) than others.

Principles of quality management suggest that outcomes depend upon structures AND processes. Hence, if trauma centers have similar structures ensured by their designation, then variations in patient outcomes must be related to differences in clinical practices. Our hypothesis is that clinical care processes for management of trauma patients are variable, and specific processes that improve patient outcomes can be identified. Also, processes that raise the costs of care without improving outcomes can be determined.

This will be a multicenter study of five civilian and military Level I trauma centers that serve a diverse population exceeding 13 million. Adult patients with moderate to severe injuries will be included (5000 patients, treated 2006-08). Clinical care processes related to initial assessment, resuscitation, hemorrhage control, operative care, critical care, and rehabilitation, as well as patient outcomes (in-hospital mortality, complications, length of stay, hospitalization costs) will be measured.

Following are the specific aims of the study:

Specific Aim 1: To identify the processes of care that predict patient outcomes including mortality, complications, costs, and length of hospital stay.

Specific Aim 2: To measure variations in practices, and the associated costs, between and within institutions.

Specific Aim 3: To calculate the potential improvement on patient outcomes with improved use of the best processes of care identified in Specific Aim 1. This will enable us to help prioritize targets for future studies.

The findings will identify “best clinical practices” in trauma that will help to shape future studies aimed at reducing harmful variations in clinical practice at trauma centers.