Mitchell Driessen (Zeist / NL), Erik van Zwet (Leiden / NL), Leontien Sturms (Zeist / NL), Mariska de Jongh (Tilburg / NL), Luke P.H. Leenen (Utrecht / NL)
Abstract text (incl. references and figure legends)
Using patient outcomes to monitor medical centre performance has become an essential part of modern health
care. However, classic league tables generally inflict stigmatization on centres rated as "poor performers", which has a
negative effect on public trust and professional morale. In the present study, we aim to illustrate that funnel plots, including
trends over time, can be used as a method to control the quality of data and to monitor and assure the quality of trauma care.
Moreover, we aimed to present a set of regulations on how to interpret and act on underperformance or overperformance
trends presented in funnel plots.
A retrospective observational cohort study was performed using the Dutch National Trauma Registry (DNTR).
Two separate datasets were created to assess the effects of healthy and multiple imputations to cope with missing values.
Funnel plots displaying the performance of all trauma-receiving hospitals in 2020 were generated, and in-hospital mortality
was used as the main indicator of centre performance. Indirect standardization was used to correct for differences in the types
of cases. Comet plots were generated displaying the performance trends of two level-I trauma centres since 2017.
Results Funnel plots based on data using healthy imputation for missing values can highlight centres lacking good data
quality. A comet plot illustrates the performance trend over multiple years, which is more indicative of a centre"s performance
compared to a single measurement. Trends analysis offers the opportunity to closely monitor an individual centres"
performance and direct evaluation of initiated improvement strategies.
This study describes the use of funnel and comet plots as a method to monitor and assure high-quality data and
to evaluate trauma centre performance over multiple years. Moreover, this is the first study to provide a regulatory blueprint
on how to interpret and act on the under or overperformance of trauma centres.
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All authors declare to have no conflict of interest, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest.