TQIP's administrative costs are less than those of other programs, making it an accessible tool for assessing performance and enhancing quality of trauma care.
[1] TQIP was preceded by surgical indicators that included the Optimal Resources for the Care of the Injured reference document, published by the ACS Committee on Trauma in 1979.
[5] A pilot study was initiated in June 2008 to refine the methodology and assess the feasibility of applying TQIP for quality improvement at different trauma centers.
The second cohort was composed of trauma patients with penetrating truncal injuries with an AIS score ≥ 3 in at least one region including the neck, thorax, and abdomen.
The results also shed light on appropriate actions to undertake in order to improve quality, such as by illuminating local or regional collaborative efforts that could implemented.
Overall, the pilot study demonstrated that TQIP's anonymous measures of relative performance could successfully allow trauma centers to identify shortcomings and facilitate quality improvement using existing resources and systems at local, regional, and national levels.
[4] TQIP utilizes a retrospective cohort of trauma patients in designated and ACS-verified Level I and II hospitals in the United States and Canada.
[2] To participate in the program, patients must meet the following inclusion criteria: be an adult greater than sixteen years of age with at least one valid ICD 9 CM diagnosis code, history of blunt or penetrating mechanisms of injury, or have an AIS score ≥ 3.
[2] Patients are excluded from the program if they have a pre-existing advance directive to withhold life-sustaining measures or are older than 65 years of age and have an isolated hip fracture.
These variables include factors such as age, race, gender, initial pulse rate in the emergency department, the mechanism of injury, etc.
It is meant as a self-reflective tool to be used in determining how to improve outcomes and decrease costs by understanding the reasons for variability and identifying best practices.
[1] TQIP reports allow hospitals to focus on outcomes and workflows, including care coordination, in-hospital processes, and resource allocation.
Despite the development of sophisticated statistical models which attempt to mitigate errors in precision, the small sample sizes of highly specific trauma patient populations will inevitably skew results.
[9] Still, high mortality status is not universal among institutions treating predominantly minority patients, and TQIP has not addressed this inequity.
Similarly, there can be great variation in how trauma centers classify DOA patients, leading to differences in treatment (e.g., resuscitation attempts or other invasive procedures).
While independent researchers have found that inclusion of ED deaths in statistical analyses yields only small, insignificant changes in TQIP outcomes, doing so eliminates bias that might otherwise be introduced.