Centers for medicare and medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma centers

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

Research output: Contribution to journalArticle

18 Scopus citations


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 (≥ 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.

Original languageEnglish (US)
Pages (from-to)771-776
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number4
Publication statusPublished - Apr 2010



  • Quality of care
  • TQIP-Trauma Quality Improvement Program: Hospital Compare
  • Trauma systems

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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