Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia

Curtis, Kate; Lam, Mary; Mitchell, Robert J.; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

doi:10.1016/j.injury.2012.10.002

Cited by 23 publications

(22 citation statements)

References 21 publications

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“…Furthermore, patients who require this high level of care are primarily referred to burn centers . The mean total healthcare cost per burn patient in high‐income countries ($88,218) was higher than the inpatient costs of trauma and acute surgery patients in one study ($17,245 and $26,468, respectively) and was also higher than the inpatient cost of trauma patients in another study (mean $10,603). Healthcare costs for burn patients during the rehabilitation phase and nonhealthcare costs such as productivity losses are likely to be high.…”

Section: Discussionmentioning

confidence: 94%

Costs of burn care: A systematic review

Hop

Polinder

Vlies

et al. 2014

Wound Repair Regeneration

130

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Burn care is traditionally considered expensive care. However, detailed information about the costs of burn care is scarce despite the increased need for this information and the enhanced focus on healthcare cost control. In this study, economic literature on burn care was systematically reviewed to examine the problem of burn-related costs. Cost or economic evaluation studies on burn care that had been published in international peer-reviewed journals from 1950 to 2012 were identified. The methodology of these articles was critically appraised by two reviewers, and cost results were extracted. A total of 156 studies met the inclusion criteria. Nearly all of the studies were cost studies (n = 153) with a healthcare perspective (n = 139) from high-income countries (n = 127). Hospital charges were often used as a proxy for costs (n = 44). Three studies were cost-effectiveness analyses. The mean total healthcare cost per burn patient in high-income countries was $88,218 (range $704-$717,306; median $44,024). A wide variety of methodological approaches and cost prices was found. We recommend that cost studies and economic evaluations employ a standard approach to improve the quality and harmonization of economic evaluation studies, optimize comparability, and improve insight into burn care costs and efficiency.

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Section: Discussionmentioning

confidence: 94%

Costs of burn care: A systematic review

Hop

Polinder

Vlies

et al. 2014

Wound Repair Regeneration

130

View full text Add to dashboard Cite

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“…For example, as LOS is not predicative of trauma treatment cost variance, perhaps a new AR-DRG should be developed, or a higher clinical complexity National Weighted Activity Unit allocated to trauma patients with polytrauma and traumatic brain injury, which are known predictors of higher treatment costs and cost variance. 8 Institutions around the world have attempted to enhance their coding accuracy by directly engaging clinicians to document clearly and comprehensively, but this strategy has proven to be both unsuccessful and difficult to sustain. Healthcare organisations need to continue to assess clinical documentation and identify problems, 35 as well as adopt site-specific strategies known to improve coding quality, such as: improved coder career opportunities; higher staffing levels; reduced throughput; and increased coder interactions with clinical staff.…”

Section: Discussionmentioning

confidence: 99%

“…6 Trauma treatment represents a significant cost to the community and different funding models are used to resource the healthcare sector with varying degrees of accuracy. 7,8 In NSW, an episode-based funding model (also known as casemix-based funding) has been adopted for acute healthcare services 9 where a healthcare facility is allocated a predetermined financial payment for each type of patient episode, defined by an Australian Refined Diagnosis-Related Group (AR-DRG). 10 For some health conditions, such as rehabilitation or palliative care, episode funding models and AR-DRG have not been found to be good indicators of the 'true' types of patient episodes.…”

mentioning

confidence: 99%

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Curtis

Lam²,

Mitchell³

et al. 2014

Aust. Health Review

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Objective. This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix.Methods. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined.Results. There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P < 0.001).Conclusions. AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed.What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.

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“…During the study period, all ACT and NSW hospitals were funded using episode, or casemix, funding model, which is based on statewide average Australian Refined Diagnosis Related Group costs . This funding model is not commensurate with the treatment costs of major trauma patients, particularly those with polytrauma . The actual costs incurred by NSW trauma patients are $134 a day higher than average; as a result, the ACT is potentially disadvantaged nearly $500 000 annually by treating NSW patients .…”

Section: Discussionmentioning

confidence: 99%

“…This funding model is not commensurate with the treatment costs of major trauma patients, particularly those with polytrauma . The actual costs incurred by NSW trauma patients are $134 a day higher than average; as a result, the ACT is potentially disadvantaged nearly $500 000 annually by treating NSW patients . With the July 2012 national implementation of activity‐based funding, there needs to be transparency around the management of charges for the use of ACT services by NSW.…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcomes of major trauma patients managed in the Australian Capital Territory

et al. 2014

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The largest demographic affected by major trauma in the ACT and surrounds is young people. Injury prevention should remain focused on road trauma but also target violence and high-risk recreation activities. Further investigation around the circumstances of major traumatic injury in young people is required. Funding and cross-border agreements should be reviewed to minimize financial disadvantage to the ACT.

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Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia

Cited by 23 publications

References 21 publications

Costs of burn care: A systematic review

Costs of burn care: A systematic review

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Incidence and outcomes of major trauma patients managed in the Australian Capital Territory

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