Low‐value injury admissions in an integrated Canadian trauma system: A multicentre cohort study
| Autor: | Thomas Stelfox, Eric Mercier, Lynne Moore, Gilles Bourgeois, Amina Belcaid, Mélanie Bérubé, Alexis F. Turgeon, François Lauzier, Belinda J. Gabbe, Marc-Aurèle Gagnon, Peter Cameron, Natalie L. Yanchar |
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| Rok vydání: | 2021 |
| Předmět: |
Canada
medicine.medical_specialty Traumatic brain injury Intraclass correlation Psychological intervention MEDLINE Cohort Studies Young Adult 03 medical and health sciences 0302 clinical medicine Trauma Centers 030225 pediatrics Health care medicine Humans 030212 general & internal medicine Young adult Child Aged Retrospective Studies business.industry General Medicine Emergency department medicine.disease 3. Good health Hospitalization Emergency medicine business Cohort study |
| Zdroj: | International Journal of Clinical Practice. 75 |
| ISSN: | 1742-1241 1368-5031 2013-2018 |
| DOI: | 10.1111/ijcp.14473 |
| Popis: | Background Injury represents 260 000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among emergency department presentations between countries and providers, but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods We conducted a retrospective multicentre cohort study based on all injury admissions in the Quebec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results The prevalence of low-value injury admissions was 16% (n = 19 163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12 345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value paediatric injury admissions; n = 922), superficial injuries (14%, n = 660) or minor spinal injuries (14%, n = 634) in adults aged 16-64 and superficial injuries in adults aged 65+ (22%, n = 2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC = 37%). Conclusion One out of six hospital admissions following injury may be of low value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce healthcare services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes. |
| Databáze: | OpenAIRE |
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