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Unblinding Trauma Outcomes Reporting: How Should We Proceed?

Learn the potential pitfalls of unblinding trauma outcomes reporting, including why standard measures aren’t applicable to trauma situations.

Much of the focus of process improvement in trauma centers has centered on public reporting and unblinding trauma outcomes. But as a field, trauma has struggled with achieving effective process improvement through public reporting, leaving many asking whether current methods of reporting are effective and how they could potentially be improved.

Dr. Mark J. Kaplan’s lecture “The Case For and Against Unblinding Trauma Center Outcomes,” now available for CME credit through AudioDigest, takes a closer look at the issue.

Public Reporting: A Complex Problem

Public reporting of trauma outcomes aligns well with a public health model, especially considering that traumatic injuries are one of our greatest health challenges.

According to Dr. Kaplan’s research, we spend $670 billion a year worldwide in combined costs and lost productivity, handling 39 million ED visits and 12.3 million hospital visits because of traumatic injury. With this burden in mind, he argues that we need methods of quality improvement and prevention. This leaves us asking how we can educate the public, since public awareness will be the cornerstone of instituting improvements.

Measures of trauma outcomes shouldn’t be the same as those used in less complex healthcare environments with fewer performance variables (cardiac surgery, for example), according to Dr. Kaplan. Trauma situations involve over 300 variable factors, including resource allocation, location and case mix index that can all influence outcomes.

And trauma care is a system that’s bigger than any individual center. It functions at the local and even regional levels to decrease morbidity and mortality, adding to variability and increasing the challenge of reporting data that can effect change. Even so, regulatory bodies still use oversimplified methods for certifying hospitals.


To listen to the full lecture, visit AudioDigest.


Informing the Public

Dr. Kaplan explains that when public transparency of trauma outcomes first became prominent, the initial thought was that consumers would increase their knowledge, make better decisions and drive improvements through increased competition, pushing out low-quality practices and performers. But trauma centers aren’t Kmart. They don’t compete with each other; they collaborate. No major trauma outcome study has proven that releasing data without the context of trauma care’s complexities improves outcomes in any significant way.

This is in part because patients don’t understand the variability of the trauma center. In a national survey cited by Dr. Kaplan, 61% of respondents indicated that they recognized injury was a leading cause of death in the U.S.; 94% expected to be taken to a trauma center but, at the same time, weren’t sure what trauma centers do or if there was even one close to their hospital.

If trauma center results are unblinded, Dr. Kaplan suggests that data be gathered for the education of the public and not for marketing efforts, as has become common. Initiatives like the “STOP THE BLEED” campaign and effective advocacy for gun control and violence reduction programs should be included in reporting. These programs have been proven to reduce mortality rates and improve outcomes and are a more effective way to use data to improve surgeons’ work.

The Downside of Public Reporting

As it stands, public reporting only supports the possibility of improvement in areas where results are measured. This potentially myopic and short-term approach means that we sacrifice broad organizational objectives. For example, we may improve mortality rates for a six-month period but miss out on long-term improvements in our work and how we’re treating patients.

Additionally, issues with the potential misrepresentation and massaging of data make outcomes appear more positive than they might be, along with the Hawthorne effect — gaming measurement periods by changing behavior while under observation, meaning results reflect that behavior and not true practices. At the same time, the Hawthorne effect isn’t completely negative if it incentivizes trauma centers to pay more attention to how they can improve outcomes.

How We Should Approach Unblinding

Unblinding reporting of trauma outcomes does have potential benefits, but it should be approached as a system-wide effort and an educational program, going beyond improved mortality rates as the only measure.

If it’s not approached properly, Dr. Kaplan explains, we could see increased confusion and decreased public confidence in trauma centers overall. Data reported should include elements like:

  • Pre- and post-hospital care.

  • Recovery and disability.

  • Cost of long-term care.

  • Results of trauma prevention programs.

  • Overall trauma prevention within a community.

Additionally, data should be reported by systems at the local, regional and national levels, not individual centers, which will prevent centers from using data in marketing. We should collaborate to create a mechanism to improve the quality and consistency of care; this will allow us to validate data over larger populations and sample sizes. The public should also be informed of trauma costs so they understand just how expensive it is to run a trauma center.

Megan D. Williams

Megan D. Williams

I'm a freelance business writer with 10 years' experience in healthcare (hospital consulting), over a decade's work in online content creation, and an MBA. I create engaging, informative content on general B2B topics, healthcare B2B, mobile healthcare, nutrition and supplements, and freelancing as a career. I have created content for clients including Samsung, Cintas, NutraScience Labs and Business Solutions Magazine. While I specialize in healthcare, my education and experience also give me the ability to create engaging and effective content on almost any business topic.

I create thought leadership articles, blogs, news stories, case studies, and website content for emerging and established B2B healthcare brands. I have a unique mix of style, industry experience, and education that brings a signature tone and competence to my work.

Experience
I have 10 years experience in revenue cycle/IT consulting for hospitals, an MBA, and I run Locutus Health Communications, a content strategy company dedicated to the B2B healthcare space. I've also been certified in online content marketing by Copyblogger Media and have been creating online content for over a decade.

My Work
I write on healthcare IT (EHR, data analytics, security, cloud storage, MU/HIPPA, etc.) at BSM Info. I also create in-depth content for my clients ranging from blogs and articles, to website content and white papers. My understanding of the culture of the industry and constant contact with advancements and trends allows me to create work that is connected, in-depth, and engaging. I specialize in revenue cycle, healthcare IT, and startup content.

My Outlook
Most importantly though, I believe B2B content in healthcare will benefit from a shift in tone...a shift to one that is rooted in the seriousness and formality of the industry, but that still understands the need for humanity and a more editorial feel. Thank you for your time

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