Predicting Hospital Quality Measures Following High-Energy Orthopaedic Trauma

Purpose: The purpose of this study was 2-fold: 1) to investigate the age-related frequency, demographics and distribution of the middle-aged and geriatric orthopedic trauma population and 2) to describe the age-related frequency and distribution of hospital quality measure outcomes and inpatient cost. Methods: All patients > 55 years of age who required orthopedic, trauma, or neurosurgery consults at 3 hospitals within an academic medical center from 2014 to 2017 were prospectively followed. On initial evaluation, each patient’s demographics, injury severity, and functional status were collected. Patients were grouped into low and high-energy mechanism cohorts and divided into 5 groups based on age. Hospital quality measures including length of stay, complications, discharge location, and cost of care was compared between age groups. Data were analyzed using ANOVA and Chi-square tests. Results: A total of 3965 patients were included in this study of which 3268 (82%) sustained low-energy trauma and 697 (18%) sustained high-energy trauma. With increasing age, more patients had more comorbidities, were less likely to be community ambulators, and more likely to use assistive devices (p < 0.05). Patients in older age groups had longer lengths of stay, more complications, were more likely to need ICU level care, and were less likely to be discharged home (p < 0.05). Rates of mortality were also greater in patients of more advanced age in both low and high-energy cohorts, and the calculated risk triage tool (STTGMA) score increased with each age bracket (p < 0.05). Total cost of care differed between age groups in the low-energy cohort (p = 0.003). Conclusion: This epidemiological study provides a clear picture of the frequency and distribution of demographic, physiologic characteristics, outcomes, and cost of care in a middle-aged and geriatric orthopedic trauma population as evaluated by the STTGMA risk tool. Risk profiling of geriatric trauma patients allows for the establishment of baseline norms.

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Can We Stratify Quality and Cost for Older Patients With Proximal and Midshaft Humerus Fractures?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321992742 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199274

Author(s):

Sanjit R. Konda ◽

Joseph R. Johnson ◽

Nicket Dedhia ◽

Erin A. Kelly ◽

Kenneth A. Egol

Keyword(s):

High Risk ◽

Length Of Stay ◽

Quality Measures ◽

Risk Groups ◽

Hospital Quality ◽

Minimal Risk ◽

Middle Aged ◽

Risk Patients ◽

Humerus Fractures ◽

Trauma Triage

Introduction: This study sought to investigate whether a validated trauma triage tool can stratify hospital quality measures and inpatient cost for middle-aged and geriatric trauma patients with isolated proximal and midshaft humerus fractures. Materials and Methods: Patients aged 55 and older who sustained a proximal or midshaft humerus fracture and required inpatient treatment were included. Patient demographic, comorbidity, and injury severity information was used to calculate each patient’s Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA). Based on scores, patients were stratified to create minimal, low, moderate, and high risk groups. Outcomes included length of stay, complications, operative management, ICU/SDU-level care, discharge disposition, unplanned readmission, and index admission costs. Results: Seventy-four patients with 74 humerus fractures met final inclusion criteria. Fifty-eight (78.4%) patients presented with proximal humerus and 16 (21.6%) with midshaft humerus fractures. Mean length of stay was 5.5 ± 3.4 days with a significant difference among risk groups (P = 0.029). Lower risk patients were more likely to undergo surgical management (P = 0.015) while higher risk patients required more ICU/SDU-level care (P < 0.001). Twenty-six (70.3%) minimal risk patients were discharged home compared to zero high risk patients (P = 0.001). Higher risk patients experienced higher total inpatient costs across operative and nonoperative treatment groups. Conclusion: The STTGMA tool is able to reliably predict hospital quality measures and cost outcomes that may allow hospitals and providers to improve value-based care and clinical decision-making for patients presenting with proximal and midshaft humerus fractures. Level of Evidence: Prognostic Level III.

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Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns

Review of Economics and Statistics ◽

10.1162/rest_a_00804 ◽

2019 ◽

Vol 101 (5) ◽

pp. 841-852 ◽

Cited By ~ 2

Author(s):

Joseph Doyle ◽

John Graves ◽

Jonathan Gruber

Keyword(s):

Risk Adjustment ◽

Quality Measures ◽

Hospital Quality ◽

High Quality ◽

Referral Patterns ◽

Hospital Choice ◽

Provider Quality ◽

Potential Failure ◽

Health Care Payment ◽

Quality Evidence

Hospital quality measures are crucial to a key idea behind health care payment reforms: “paying for quality” instead of quantity. Nevertheless, such measures face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns when ranking hospitals. In this paper, we test whether patients treated at hospitals that score higher on commonly used quality measures have better health outcomes in terms of rehospitalization and mortality. To compare similar patients across hospitals in the same market, we exploit ambulance company preferences as an instrument for hospital choice. We find that a variety of measures that insurers use to measure provider quality are successful: choosing a high-quality hospital compared to a low-quality hospital results in 10% to 15% better outcomes.

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An Exploration of the Impact of EMR Capabilities on Hospital Quality Measures in U. S.

2016 49th Hawaii International Conference on System Sciences (HICSS) ◽

10.1109/hicss.2016.397 ◽

2016 ◽

Author(s):

Yousra Harb ◽

Surendra Sarnikar ◽

Cherie Noteboom

Keyword(s):

Quality Measures ◽

Hospital Quality ◽

The Impact

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Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (PAIN Study)

Journal of Orthopaedic Trauma ◽

10.1097/01.bot.0000524642.24673.87 ◽

2017 ◽

Vol 31 (9) ◽

pp. e308

Keyword(s):

Pain Management ◽

High Energy ◽

Orthopaedic Trauma ◽

Long Term Outcomes

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Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures

Circulation ◽

10.1161/circulationaha.115.014281 ◽

2015 ◽

Vol 132 (14) ◽

pp. 1347-1353 ◽

Cited By ~ 43

Author(s):

Larry A. Allen ◽

Gregg C. Fonarow ◽

Li Liang ◽

Phillip J. Schulte ◽

Frederick A. Masoudi ◽

...

Keyword(s):

Heart Failure ◽

Quality Measures ◽

Hospital Quality

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The denominator problem: national hospital quality measures for acute myocardial infarction

BMJ Quality & Safety ◽

10.1136/bmjqs-2015-004888 ◽

2016 ◽

Vol 26 (3) ◽

pp. 189-199 ◽

Cited By ~ 2

Author(s):

Jeffrey Bruckel ◽

Xiu Liu ◽

Samuel F Hohmann ◽

Andrew S Karson ◽

Elizabeth Mort ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Measures ◽

Hospital Quality ◽

National Hospital

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How Did the Restrictions Effect the Orthopaedic Trauma Surgery During Covid-19 Pandemic at a Level 1 Tertiary Trauma Hospital?

10.21203/rs.3.rs-102396/v1 ◽

2020 ◽

Author(s):

Bulent Kilic ◽

Deniz Gulabi ◽

Anıl Agar ◽

Halil Buyukdogan ◽

Adem Sahin ◽

...

Keyword(s):

Trauma Surgery ◽

High Energy ◽

Control Group ◽

Time Interval ◽

Orthopaedic Trauma ◽

Fracture Type ◽

Trauma Mechanism ◽

Number Of Patients ◽

Significant Difference ◽

Fracture Types

Abstract BackgroundThe aim of the study was to evaluate and compare the demographic characteristics, the trauma mechanism, and fracture types between patients under 20 years of age, 20-65 years of age, and over 65 years of age between the COVID-19 pandemic and the pre-pandemic period.MethodsPatients who were hospitalized and treated for orthopedic treatment between 10 March and 1 June during the pandemic period were retrospectively analyzed. Control group consisted of patients admitted to the hospital in the same time interval in 2019.The patients were divided into three groups, under 20 years of age, between 20-65 years of age, and over 65 years of age. The patients’ data included age, gender, trauma mechanism, fracture type, any COVID-19 radiological or clinical symptoms.ResultsThe number of patients > 65 years old admitted to orthopaedic trauma center were high at pandemic interval compared to pre-pandemic time. When the groups were compared for patients of 20-65 years old; there was a significant difference for the fracture type (p<0.05). Lower extremity fractures were high at pre-pandemic group whereas multiple traumas were high at pandemic group. For sub-group 20-65 ages, low energy traumas were higher at pre-pandemic group whereas high energy traumas were more frequent at pandemic group.ConclusionWe observed a decrease in fracture admission to ortopaedic trauma centers during COVID-19 pandemic for subgroups of < 20 years old and 20-65 years old ages, whereas there was a significant increase for > 65 years old age, most of them related to the osteoporotic hip fractures. So that older age group should be encouraged to mobilized at home and have permission to walk and make physical activity to avoid osteoporosis for a limited time daily.

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