Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study
| Autor: | Simon Berthelot, Henry T. Stelfox, Lynne Moore, Alexis F. Turgeon, Catherine Truchon, David C. Evans, Jeffrey S Hoch, Belinda J. Gabbe, Teegwendé V. Porgo, Julien Clément, François Lauzier, Peter Cameron, Francis Bernard |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Intraclass correlation law.invention 0302 clinical medicine Injury Severity Score Trauma Centers law 80 and over Medicine Registries Patient group Determinants General Environmental Science Aged 80 and over 030222 orthopedics Level iv Injuries and accidents Middle Aged Intensive care unit Quartile Evidence-Based Practice Public Health and Health Services Resource use Female Adult medicine.medical_specialty Canada Physical Injury - Accidents and Adverse Effects Critical Care Resource use intensity Clinical Sciences Nursing Trauma 03 medical and health sciences Clinical Research Inter-provider variations Humans Activity-based costing Retrospective Studies Aged business.industry 030208 emergency & critical care medicine Retrospective cohort study Length of Stay Confidence interval Good Health and Well Being Orthopedics Emergency medicine General Earth and Planetary Sciences Wounds and Injuries business |
| Zdroj: | Injury, vol 50, iss 6 Porgo, Teegwendé V; Moore, Lynne; Truchon, Catherine; Berthelot, Simon; Stelfox, Henry T; Cameron, Peter A; et al.(2019). Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study.. Injury. doi: 10.1016/j.injury.2019.03.038. UC Office of the President: Research Grants Program Office (RGPO). Retrieved from: http://www.escholarship.org/uc/item/95r6w28n |
| DOI: | 10.1016/j.injury.2019.03.038. |
| Popis: | 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 f2. 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 f2 = 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] , [5] , [6] ]), particularly for the OR (28% [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [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. |
| Databáze: | OpenAIRE |
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