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The impact of individual physicians on outcomes after trauma: is it the system or the surgeon?
- Source :
-
The Journal of surgical research [J Surg Res] 2018 Sep; Vol. 229, pp. 51-57. Date of Electronic Publication: 2018 Apr 16. - Publication Year :
- 2018
-
Abstract
- Background: Benchmarking of mortality outcomes across the country has revealed major differences in survival based on the trauma center at which a patient receives care. The role of the individual surgeon in determining trauma outcomes is unknown. Most believe that differences in outcomes are primarily driven by system- and process-based variations. Our objective was to determine if variation in individual surgeon outcomes could help explain difference in survival after trauma.<br />Methods: Analysis of trauma patients in the Florida State Inpatient Database from 2010 to 2014. The presence of unique physician identifiers, in addition to hospital identifiers, rendered this data set ideal for performance of multilevel analysis. The amount of the variation attributable to surgeon-level variation was calculated using multilevel random-effects models controlling for patient clinical factors (such as injury severity and comorbidities/age) and hospital-level factors, such as case mix and bed size.<br />Results: There were 31 hospitals, 175 surgeons, and 65,706 admissions. The overall mortality rate was 5.6%. The average mortality rate across surgeons ranged from 0% to 17.4% (mean 0.4%, standard deviation 1.85). At the individual surgeon level, when controlling for clinical and hospital-level factors, 9% of this variation was attributable solely to the surgeon.<br />Conclusions: At the state level, we found that differences in outcomes among trauma centers are impacted by individual surgeon-level variation. Implementation of protocolized, system-based trauma care is useful for improving the overall quality of care for injured patients but does not entirely negate surgeon-specific variations in management.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Benchmarking statistics & numerical data
Clinical Competence standards
Clinical Competence statistics & numerical data
Critical Pathways standards
Critical Pathways statistics & numerical data
Female
Florida epidemiology
Hospital Mortality
Hospitals standards
Humans
Injury Severity Score
Length of Stay statistics & numerical data
Male
Middle Aged
Surgeons standards
Survival Rate
Treatment Outcome
Wounds and Injuries diagnosis
Wounds and Injuries surgery
Young Adult
Hospitals statistics & numerical data
Outcome and Process Assessment, Health Care statistics & numerical data
Surgeons statistics & numerical data
Trauma Centers statistics & numerical data
Wounds and Injuries mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1095-8673
- Volume :
- 229
- Database :
- MEDLINE
- Journal :
- The Journal of surgical research
- Publication Type :
- Academic Journal
- Accession number :
- 29937016
- Full Text :
- https://doi.org/10.1016/j.jss.2018.02.051