BENCHMARKING THE QUALITY-MONITORING PROCESS - A COMPARISON OF OUTCOMES ANALYSIS BY TRAUMA AND INJURY SEVERITY SCORE (TRISS) METHODOLOGY WITH THE PEER-REVIEW PROCESS

Background: One measure of optimal function within a trauma center is the ability to critically examine outcomes from the process of care wi thin the institution, yet guidelines for evaluation of the peer-review process are lacking. This study was conducted to determine the correl ation between mortality analysis performed by the peer-review process (PR) within a trauma division and outcome analysis as determined by Tr auma and Injury Severity Score (TRISS) methodology. Methods: The morta lity peer-review data for an entire year at our level I trauma center served as the study population, Information was obtained on probabilit y of survival, and a determination of preventability was made using st andard, preexisting criteria, Peer review involves assigning each outc ome to a specific category through tile process of multidisciplinary a ssessment, Probability of survival data was not used for this purpose, Kappa analysis was performed to determine the degree of agreement in each category and then tested for significance, Results: One hundred f our deaths in 1,868 trauma patients (5.5%) were reviewed at our multid isciplinary conference, Outcomes were judged as preventable, potential ly preventable, or nonpreventable. Death directly related to exsanguin ation was typically categorized as potentially preventable. Kappa anal ysis demonstrated the greatest agreement between PR and TRISS in the n onpreventable category (kappa = 0.213) and the least agreement in the potentially preventable category (kappa -0.197), Overall, the kappa Z statistic was nonsignificant (Z = 1.24). Conclusions: Multidisciplinar y peer-review outcomes analysis is at least as effective as the comput er-generated TRISS probability of survival data for evaluating quality of care in a trauma center and may be more effective for analysis of potentially preventable outcomes.