TY - JOUR
T1 - Canadian benchmarks for acute injury care
AU - Moore, Lynne
AU - Evans, David
AU - Yanchar, Natalie L.
AU - Thakore, Jaimini
AU - Stelfox, Henry Thomas
AU - Hameed, Morad
AU - Simons, Richard
AU - Kortbeek, John
AU - Clément, Julien
AU - Lauzier, François
AU - Turgeon, Alexis F.
N1 - Funding Information:
Funding: L. Moore, H. Stelfox and A. Turgeon are supported by a
Publisher Copyright:
© 2017 Joule Inc. or its licensors.
PY - 2017/12
Y1 - 2017/12
N2 - Background: Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions. Methods: Benchmarks were derived using data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma centre in Canada and from the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, age 65 years or older. We assessed predictive validity using measures of discrimination and calibration, and performed sensitivity analyses to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally. Results: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve 0.886, Hosmer-Lemeshow 36). The LOS risk-adjustment model predicted 29% of the variation in LOS. Overall, observed:expected ratios of mortality and mean LOS generated by an analytically simple model correlated strongly with those generated by analytically complex models (r > 0.95, κ on outliers > 0.90). Conclusion: We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centres using Excel (see the appendices, available at canjsurg. ca). The program can be implemented using local trauma registries, providing that at least 100 patients are available for analysis.
AB - Background: Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions. Methods: Benchmarks were derived using data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma centre in Canada and from the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, age 65 years or older. We assessed predictive validity using measures of discrimination and calibration, and performed sensitivity analyses to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally. Results: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve 0.886, Hosmer-Lemeshow 36). The LOS risk-adjustment model predicted 29% of the variation in LOS. Overall, observed:expected ratios of mortality and mean LOS generated by an analytically simple model correlated strongly with those generated by analytically complex models (r > 0.95, κ on outliers > 0.90). Conclusion: We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centres using Excel (see the appendices, available at canjsurg. ca). The program can be implemented using local trauma registries, providing that at least 100 patients are available for analysis.
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U2 - 10.1503/cjs.002817
DO - 10.1503/cjs.002817
M3 - Article
C2 - 28930046
AN - SCOPUS:85035764832
SN - 0008-428X
VL - 60
SP - 380
EP - 387
JO - Canadian Journal of Surgery
JF - Canadian Journal of Surgery
IS - 6
ER -