Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Porgo, Teegwendé V.; Moore, Lynne; Truchon, Catherine; Berthelot, Simon; Stelfox, Henry T.; Cameron, Peter A.; Gabbe, Belinda J.; Hoch, Jeffrey S.; Evans, David C.; Lauzier, François; Bernard, Francis; Turgeon, Alexis F.; Clément, Julien
• Is Part Of: Injury. Volume 50:Issue 6(2019)
• Page Start: 1192
• Page End: 1201
• Publication Date: 2019-06
• Subjects: Trauma -- Resource use intensity -- Activity-based costing -- Determinants -- Inter-provider variations; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.03.038
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Resource use in a mature, inclusive Canadian trauma system is not solely explained by baseline risk of patients. The strongest determinant of resource use was discharge destination (Cohen's f 2 = 7%) which may reflect delays in access to post-acute care. While risk-adjusted resource use increased with increasing age and comorbidities for the regular ward and ICU, it decreased for the OR. Risk-adjusted resource use was 18% higher in level I centres compared to level IV centres. We observed significant variations in resource use across centres (ICC = 5%; 95% CI = 4–6), particularly for the OR (28% [20–40 ]). 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% [20–40 ]). 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, in-hospital 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.