American College of Surgeons Committee on Trauma

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American College of SurgeonsCommittee on Trauma

• Trauma Quality Improvement Program (TQIP)

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TQIP principles

• The goal of TQIP is to improve the quality of
  care of trauma patients
• Leads to lower mortality
• Fewer complications
• Lower costs
• Uses existing trauma center staff and data
  collection infrastructure
• Based on the National Trauma Data Standard
• Relies on collective expertise of COT
  sub-committees

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Training

• In person training for registrars
• Online course continuously available
• Quarterly case studies to improve coding
• Web conferences
• Online registrar community

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Standard/Validated Data Collection

• Based on National Trauma Data Standard
• Automated validation
• Quarterly data submission for ongoing validation
• External validation to improve coding at your
  site through site visits

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Identifies how your center performs compared to
others
Risk Adjusted Benchmarking
Your Center
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NTDB vs TQIP Benchmarking

• NTDB
• Compares to trauma centers of similar size and
  level
• Raw data on patient characteristics
• Crude mortality does not take into account data
  quality and injury severity

• TQIP
• Uses patient cohorts to standardize comparisons
  across centers
• Includes Level I and II centers, adult patients
• Risk adjusted outcomes, including mortality and
  complications

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Patient Cohorts

• Blunt multisystem injury
• Blunt trauma with severe injuries (AISgt3) in at
  least two body regions
• Penetrating truncal injury
• Severe torso trauma due to GSW/stab/impalement
• Blunt single system injury
• Blunt trauma with a severe injury limited to a
  single body region

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Patient Cohorts

• Each cohort challenges different aspects of
  clinical care
• Prompt assessment surgical intervention
• Multidisciplinary coordination
• Each population might be differently represented
  at any single trauma center
• Differential outcomes across the cohorts for a
  particular center better focus PI efforts

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Measuring Processes of Care

• What practices are associated with better
  outcomes?
• Fields in NTDS lack detail to capture specific
  processes

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TQIP Process Measures
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Improved Outcomes

• Hospital mortality rates
• Hospital complication rates
• Utilization of resources compared to other trauma
  centers
• Hospital Length of Stay
• ICU Length of Stay
• Ventilator Days

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Cost Benefits

• Potential for cost sharing across several
  services
• e.g. Trauma (Gen Surg), Neurosurgery, Orthopedics
• Registrar training to ensure more accurate
  injury, complication comorbidity coding
• Eliminate significant under-billing
• Demonstrates commitment to performance
  improvement
• May help contracting with third-party payers and
  employers
• Implementation of best practices leads to lower
  complications
• Potentially higher reimbursement in the emerging
  P4P environment
• Competitive edge in the emerging era of "public
  reporting"

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Co-Morbid Conditions

• Each co-morbid condition documented and submitted
  may increase your reimbursement by 700 - 10,000

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Decrease Complications

• Benchmarking complications with comparisons to
  other centers will help those with higher
  complications rates to learn from higher
  performing centers and reduce complications.

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Decrease Lengths of Stay

• Active Care Coordination
• Early discharge planning
• Active social work
• Rapid radiology final reads
• Early spine clearance