and a major education program. Data was collected from 2845 toolsover eight months and involved three phases: a baseline phase pre-intervention; 6 weeks post-intervention; and 6 months post-intervention.

RESULTS: During phase I, the baseline period, 56% of eligiblepatients received beta blockers, but targeted measures (pre-inductionheart rate �70 or systolic BP �110) were achieved in only 11% ofpatients. Phase II saw a significant overall increase in beta blockeradministration (79%) as well as efficacy (50%). However, duringphase III (two months to six months post-implementation), the rateof beta blocker administration fell to 61% overall, an insignificantdifference from overall baseline, and actually lower than the academiccenter’s baseline (77%), while overall efficacy remained stable at52%. Significant differences between the academic and communityhospitals were observed throughout the study.

CONCLUSIONS: Our data suggest that implementation of a qual-ity program for beta blockade is significantly impacted by the pres-ence or absence of ongoing physician and staff education beyond thestudy period. Additionally, initial positive results, without periodicreview of follow-up data, must be viewed with caution in these typesof interventions.

In hospital mortality after traumatic head injury:effect of patient insurance statusThomas Mitchell MD, Stephen DiRusso MD, PhD,Thomas Sullivan BS, Nanakram Agarwal MD, MPH,Deborah Benzil MDNew York Medical College, Westchester Medical Center, Valhalla, NY

INTRODUCTION: This study was undertaken to characterize theeffect of insurance status on inhospital mortality in patients withTraumatic Closed Head Injury (TCHI).

METHODS: Patient Population: New York Statewide Planning andResearch Cooperative System (SPARCS) hospital discharge datasetfrom 1991-2001. Patients with TCHI were identified using ICD-9head injury diagnosis codes. Statistical Analysis: A logistic regressionmodel was used to predict mortality in patients with TCHI. Signif-icant variables in that model included age, Relative Head InjurySeverity Scale (RHISS), ICD9 injury severity score (ICISS), age,volume of treated patients, and mechanism of injury. The SPARCSdataset includes a primary insurance payor variable which groupspatient pay status into 18 categories. This was included as a categor-ical variable to the LR model in a stepwise fashion, and significantpayor status components were identified. Odds ratios were com-puted for significant insurance status variables, referenced to self paystatus.

RESULTS: 178,642 patients were identified as having TCHI. TheArea Under the Receiver Operating Characteristic Curve for mortal-ity prediction for both models was 0.93. Payor status as a whole wasan independent predictor of mortality (p�0.001). All significantinsurance categories had improved odds ratios for survival over selfpay patients. Odds ratios for several significant payors: Workman’sComp: 3.46, Champus/VA: 2.50, No Fault: 2.39, Commercial 2.35,Blue Cross: 2.26, HMO: 2.10, Medicaid: 1.66, Medicare: 1.31.

CONCLUSIONS: In NY State, self pay status portends a higherhospital mortality in patients with TCHI.

S74 Quality, Outcomes, and Cost II J Am Coll Surg