Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study

Abstract

Background: Variations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity. Objectives: To estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use. Methods: We conducted a retrospective cohort study including 16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f 2 . We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals. Results: We included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f 2 = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% ). Conclusions: Resource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, inhospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting.

Direct Cost of Illness for Spinal Cord Injury: A Systematic Review

“…Finally, the remaining 30 studies were included here. Most studies originated in North America (the U.S.: 15 studies, 15 - 29 and Canada: 7 30 - 36 ); and the rest were conducted in Australia, 37 , 38 China, 39 Mexico, 40 Nigeria, 41 Taiwan, 42 , 43 and Tanzania. 44 Sample sizes ranged from 34 to 15,510, and settings varied from hospital-based to nationwide.…”

“…The average charges for acute care of SCI regardless of the neurologic category was reported from $92,220 to $337,400 in the U.S. 17 , 26 , 29 The corresponding costs were $29,550 to $61,180 in Australia 37 , 38 and $9,980 to $34,202 in Canada. 32 , 33 , 36 The acute care costs as a percentage of the GDP per capita were variable from 68% to 110% for Australia, 47% to 73% for Canada, 281% to 590% for the US, and from 12% to 123% for low-to-middle income countries (LMIC) ( Table 3 ).…”

Intensity of hospital resource use following traumatic brain injury: a multicentre cohort study, 2013–2016

“…14 Detailed information on this costing method for injury admissions in Quebec has been published elsewhere. 15 In brief, units of hospital resource use, extracted from the trauma registry, were multiplied by unit costs, extracted from hospital financial reports, for each of 6 activity centres: emergency department, general ward, operating room, ICU, medical im aging and para-clinical services (physiotherapy, respiratory therapy, psychotherapy and occupational therapy). For example, hospital resource use for a patient who went through the emergency department ($253.37/visit), au-delà de 2 fois plus élevée que chez les patients ayant reçu leur congé de l'hôpital.…”

Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?

“…6 Thus, fostering higher efficiency and efficacy of healthcare delivery during IFR for the tSCI populationrepresenting the most resource-intense trauma patient groupis crucial for healthcare systems. 7,8 Wait time for transfer from the traumatology care to IFR admission can be attributed to several factors, such as resources availability and healthcare policies. Delays in the continuum of care processes are associated with occurrence of medical complications such as immobility and emotional distress.…”

“…This demographic shift is contributing to a rapid increase in rehabilitation burden, which is expected to increase by more than 30% in the years to come 6 . Thus, fostering higher efficiency and efficacy of healthcare delivery during IFR for the tSCI population—representing the most resource-intense trauma patient group—is crucial for healthcare systems 7,8 …”