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  • Establishing Standard Performance Measures in Adult Traumatic Brain Injury Patients: A Nationwide Inpatient Sample Database Study

    Final Number:

    Brian M Corliss; Kristopher G Hooten MD; Sarah Shireen Gul MD; Dan Neal MS; Gregory J. Murad MD; Maryam Rahman MD MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics, which illustrate the overall quality of care of an institution. The incidences of PSIs and HACs in traumatic brain injury (TBI) patients were determined using the nationwide inpatient sample (NIS) database.

    Methods: The NIS database was queried for patients admitted with ICD-9 diagnosis codes consistent with TBI. The incidences of PSIs and HACs were determined for TBI patients and compared between teaching and non-teaching hospitals. A logistic regression model was created to estimate the effects of insurance status on PSIs, HACs, and patient outcomes.

    Results: There were 15,403 total PSIs amongst 24,012 TBI patients. Teaching hospitals had a higher incidence of PSIs (653 per 1000 patients) compared to non-teaching hospital (615 per 1000 patients; p=0.0016) as well as a higher fraction of patients suffering at least one PSI (54.0% vs 50.8%; p = 0.004. There were only 165 HACs amongst 24,012 TBI patients. There was no significant difference between teaching and non-teaching hospitals in incidence of HACs; HACs were more common, however, in Medicaid patients compared to privately insured patients (8.9 vs 5.0 HACs/1000 patients; p = 0.0015.) Multivariate analyses comparing the Medicaid and private insurance patients demonstrated no difference between the groups in either poor outcome or mortality, however, the length of stay for Medicaid patients was prolonged 2.0 days compared with private insurance (95% CI [1.35, 2.62]; p<0.0001.)

    Conclusions: Clinical outcomes following TBI were not affected by insurance status. Patients treated in teaching hospitals suffered a higher incidence of PSIs, although this was not controlled for injury severity. These data may be used as reference values for hospitals reporting their own rates and seeking to improve the quality of care they provide for TBI patients.

    Patient Care: Ongoing intra- and interhospital comparsions of complication rates are vital for identifying and correcting disparities in healthcare delivery. These statistics are the necessary foundation of any effort to improve upon PSI or HAC rates in TBI patients.

    Learning Objectives: To be able to cite relevant statistics related to in-hospital patient safety and iatrogenic complications in TBI patients. To be able to identify socioeconomic and healthcare systems factors related to increased PSI and HAC in hospitalized TBI patients.


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