Interhospital Variations in Resource Use Intensity for In-hospital Injury Deaths
| Autor: | Imen Farhat, Julien Clément, François Lauzier, Henry T. Stelfox, Alexis F. Turgeon, Teegwendé V. Porgo, Coralie Assy, Amina Belcaid, Simon Berthelot, Belinda J. Gabbe, Lynne Moore |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Intraclass correlation Traumatic brain injury Risk Assessment Young Adult Trauma Centers Brain Injuries Traumatic Humans Medicine Hospital Mortality Registries Aged Retrospective Studies Aged 80 and over business.industry Incidence (epidemiology) Quebec Retrospective cohort study Middle Aged medicine.disease Hospitals Intensity (physics) Emergency medicine Population study Resource use Female Surgery business Follow-Up Studies Cohort study |
| Zdroj: | Annals of Surgery. 275:e107-e114 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000003922 |
| Popis: | OBJECTIVE Evaluate interhospital variation in resource use for in-hospital injury deaths. BACKGROUND Significant variation in resource use for end-of-life care has been observed in the US for chronic diseases. However, there is an important knowledge gap on end-of-life resource use for trauma patients. METHODS We conducted a multicenter, retrospective cohort study of injury deaths following hospitalization in any of the 57 trauma centers in a Canadian trauma system (2013-2016). Resource use intensity was measured using activity-based costing (2016 $CAN) according to time of death (72 h, 3-14 d, ≥14 d). We used multilevel log-linear regression to model resource use and estimated interhospital variation using intraclass correlation coefficients (ICC). RESULTS Our study population comprised 2044 injury deaths. Variation in resource use between hospitals was observed for all 3 time frames (ICC = 6.5%, 6.6%, and 5.9% for < 72 h, 3-14 d, and ≥14 d, respectively). Interhospital variation was stronger for allied health services (ICC = 18 to 26%), medical imaging (ICC = 4 to 10%), and the ICU (ICC = 5 to 6%) than other activity centers. We observed stronger interhospital variation for patients < 65 years of age (ICC = 11 to 34%) than those ≥65 (ICC = 5 to 6%) and for traumatic brain injury (ICC = 5 to 13%) than other injuries (ICC = 1 to 8%). CONCLUSIONS We observed variation in resource use intensity for injury deaths across trauma centers. Strongest variation was observed for younger patients and those with traumatic brain injury. Results may reflect variation in level of care decisions and the incidence of withdrawal of life-sustaining therapies. |
| Databáze: | OpenAIRE |
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