Trauma Quality Improvement Program
Risk-adjusted data program for reducing variability in trauma outcomes.
The Trauma Quality Improvement Program (TQIP) was launched in 2008 by the American College of Surgeons Committee on Trauma. It supplies risk-adjusted data to help reduce differences in outcomes for adult trauma patients and to share best practice guidelines for improving care. By using national data, TQIP lets hospitals assess how their trauma centers perform compared to others. Its administrative costs are lower than those of similar programs, making it a budget-friendly tool for evaluating performance and enhancing trauma care quality.
Mortality and complication rates vary across U.S. trauma centers, due to differences in patient populations and care quality. The Institute of Medicine’s 1999 report *To Err is Human* highlighted the need to address such variability and inefficiencies. In response, Dr. John Fildes formed an ad hoc work group to design a validated, risk-adjusted quality improvement system based on outcomes. The group aimed to use existing trauma infrastructure, drawing on each hospital’s registry data from the National Trauma Data Bank via the National Trauma Data Standard. This effort led the American College of Surgeons to create TQIP.
Earlier efforts included the 1979 ACS Committee on Trauma document *Optimal Resources for the Care of the Injured*, which set a framework for trauma center verification. The Major Trauma Outcome Study (1982–1989) then established national trauma care standards and developed the Trauma Injury Severity Score to estimate a patient’s survival probability. Later, the 2006 National Study of the Costs and Outcomes of Trauma examined differences in spending and results across hospitals.
A pilot study began in June 2008 to refine TQIP’s methods and test its feasibility for quality improvement. Twenty-three Level I and II trauma centers volunteered and were selected, all with ACS verification. Level I centers are usually university-based with comprehensive services; Level II centers were included to broaden geographic and patient diversity and strengthen statistical analysis. Each center received registrar training on TQIP objectives, data fields, and NTDS definitions, with follow-up via webinars, conference calls, and test case abstraction.
Using NTDB data from patients admitted between January 1 and December 1, 2007, three patient groups were created. The first group had blunt multisystem injuries with an Abbrevi
- initiated
- 2008
- field
- Trauma care quality improvement
- administered_by
- American College of Surgeons Committee on Trauma
- preceded_by
- Optimal Resources for the Care of the Injured (1979) and Major Trauma Outcome Study (1982–1989)
- key_feature
- Risk-adjusted mortality and complication data for Level I and II trauma centers
Lore & Background
TQIP was preceded by surgical indicators including the 1979 Optimal Resources for the Care of the Injured document and the Major Trauma Outcome Study (1982–1989), which established national trauma standards and the Trauma Injury Severity Score. A pilot study began in June 2008 with 23 volunteer Level I and II trauma centers to refine methodology and assess feasibility. Using 2007 NTDB data, three patient cohorts were created: blunt multisystem, penetrating truncal, and blunt single-system injuries. Results distributed in June 2009 showed differences in risk-adjusted mortality rates between low- and high-outlier centers, with the single-system cohort having mortality 5.9 times higher at high-outlier facilities.
Reader's Guide
TQIP's significance lies in its ability to provide hospitals with objective, risk-adjusted performance comparisons using existing trauma registry data, at lower administrative costs than other programs. The pilot study demonstrated that anonymous measures of relative performance could help trauma centers identify shortcomings and facilitate quality improvement using existing resources. As of 2014, over 200 Level I and II trauma centers in the United States and Canada participate. TQIP categorizes patients into cohorts (blunt multisystem, penetrating truncal, shock, isolated TBI, elderly without hip fracture) and measures mortality, complications, and resource use. Statistical analyses use an 18-variable logistic regression model to produce observed-to-expected ratios with 90% confidence intervals. The program is intended as a self-reflective tool, not for marketing or competitive advantage.
Did You Know?
- TQIP was initiated in 2008 by the American College of Surgeons Committee on Trauma.
- The pilot study involved 23 volunteer Level I and II trauma centers and used 2007 NTDB data.
- TQIP's administrative costs are less than those of other programs.
- As of 2014, over 200 Level I and II trauma centers in the United States and Canada participate.
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