The ED.TRAUMA Study: Evaluating the Discordance of Trauma Readmission And Unanticipated Mortality in the Assessment of Hospital Quality

Date of Award

Spring 2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Lichtman, Judith


Trauma is a common, high-risk, and high-cost condition that uniquely affects the health of older adults. Through this dissertation, we built on existing efforts to expand external benchmarking in trauma from a historical focus on in-hospital mortality to include a broader array of additional, long-term quality-metrics. To do so we: (1) assessed the distributions of proposed quality-metrics and ascertained their correlations with the current benchmarking standard (in-hospital mortality), (2) considered the utility of implementing proposed quality-metrics as a combined composite score and analyzed associations between hospital quality and important hospital-level risk-factors when trauma quality for older adults was defined based on (a) in-hospital mortality versus (b) composite scores, (3) investigated the potential influence of death as a semi-competing risk in the assessment of readmissions among older adult trauma patients, and (4) looked at the potential utility of implementing a process measure-based approach to long-term outcome improvement among older adults hospitalized for hip fracture based on the success of England’s Hip Fracture Best Practice Tariff. The findings from this work are hoped to have a major, direct impact on how the quality of care for older adults is measured, aiding in determining the future of clinical care for older adult trauma patients while simultaneously informing the development of meaningful and strong quality metric models with applications to both trauma and other non-trauma conditions.

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