Superusers: Drivers of health care resource utilization in the national trauma population

Gil, Lindsay A.; Kothari, Anai N.; Brownlee, Sarah A.; Ton-That, Hieu; Patel, Palak; Gonzalez, Richard P.; Luchette, Fred A.; Anstadt, Michael J.

doi:10.1016/j.surg.2018.04.046

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…Patients with infrequent complications but exorbitant cost, or “super-users,” represent between 1 and 5% of the population but are responsible for 20–50% of national healthcare expenditures. 37 , 38 Researchers and policymakers have therefore debated whether mitigation of high-cost infrequent complications should be prioritized over that of low-cost frequent complications. 39 Our analysis demonstrates that within the PD population, both can have a profound impact on the fiscal stability of hospital systems.…”

Section: Discussionmentioning

confidence: 99%

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Acher

Barrett

Schwartz

et al. 2021

Journal of Gastrointestinal Surgery

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Introduction Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients. Methods Hospital cost data from date of discharge to postoperative day 90 were merged with 2008-2018 NSQIP data. Early readmission was within 30 days of surgery, and late readmission was 30 to 90 days from surgery. Regression analyses for readmission controlled for patient comorbidities, complications, and surgeon. Results Of 230 patients included, 58 (25%) were readmitted.

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Section: Discussionmentioning

confidence: 99%

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Acher

Barrett

Schwartz

et al. 2021

Journal of Gastrointestinal Surgery

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“…The authors ultimately concluded that superusers were more likely to be black, male, have higher ISS, and have lower GCS. 3 An analysis of 83 ICUs in 31 hospitals across the United States from 2002 to 2007 conducted by Kramer et al found that superusers were more likely to be male and of older age. They also found that these superusers had higher severity of illness, mechanical ventilation, and ICU readmission and were more likely to have undergone emergency surgery.…”

Section: Discussionmentioning

confidence: 99%

“…After a review of the literature, additional variables of interest (gunshot wound [GSW] to the abdomen, reintubation, major surgery, and penetrating trauma) were also included. 3,[5][6][7][8]…”

Section: Data Pointsmentioning

confidence: 99%

“…Furthermore, corroborative data detailing specific demographic statistics and mechanisms of injury within the trauma superuser population remain scarce. 3 Although the literature is replete with investigations detailing resource utilization within multiple diseases processes, few works have analyzed the composition of specific patient subsets-particularly the trauma population. The purpose of this investigation is to elucidate this under-analyzed facet of the high resource utilizing literature with respect to this underrepresented subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Trauma High Resource Consumers in a Mature Trauma System

Morgan

Bradburn

Vernon

et al. 2020

The American Surgeon

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Background Extended hospital length of stay (LOS) is widely associated with significant healthcare costs. Since LOS is a known surrogate for cost, we sought to evaluate outliers. We hypothesized that particular characteristics are likely predictive of trauma high resource consumers (THRC) and can be used to more effectively manage care of this population. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003-2017 for all adult (age ≥15) trauma patients admitted to accredited trauma centers in Pennsylvania. THRC were defined as patients with hospital LOS two standard deviations above the population mean or ≥22 days (p<0.05). Patient demographics, comorbid conditions and clinical variables were compared between THRC and non-THRC to identify potential predictor variables. A multilevel mixed-effects logistic regression model controlling for age, gender, injury severity, admission Glasgow coma score, systolic blood pressure, and injury year assessed the adjusted impact of clinical factors in predicting THRC status. The National Trauma Data Bank (NTDB) was retrospectively queried from 2014-2016 for all adult (age ≥15) trauma patients admitted to state-accredited trauma centers and likewise were assessed for factors associated with THRC. Results A total of 465,601 patients met inclusion criteria [THRC: 16,818 (3.6%); non-THRC 448,783 (96.4%)]. Compared to non-THRC counterparts, THRC patients were significantly more severely injured (median ISS: 9 vs. 22, p<0.001). In adjusted analysis, gunshot wound (GSW) to the abdomen, undergoing major surgery and reintubation along with injury to the spine, upper or lower extremities were significantly associated with THRC. From the NTDB, 2 323 945 patients met inclusion criteria. In adjusted analysis, GSW to the abdomen was significantly associated with THRC. Penetrating injury overall was associated with decreased risk of being a THRC in the NTDB dataset. Those who had either GSW to abdomen, surgery, or reintubation required significantly longer LOS (p<0.001). Conclusions Reintubation, major surgery, gunshot wound to abdomen, along with injury to the spine, upper or lower extremities are all strongly predictive of THRC. Understanding the profile of the THRC will allow clinicians and case management to proactively put processes in place to streamline care and potentially reduce costs and LOS.

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The Incremental Hospitalization Cost of Significant Transport-Related Traumatic Brain Injury

Deynse¹,

Belleghem²,

Hubloue³

et al. 2020

Journal of Head Trauma Rehabilitation

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Aim: This study aims to determine the incremental cost of acute hospitalization for traumatic brain injury (TBI) compared with matched controls. A second purpose is to identify the factors contributing to this hospital costs. Methodology: Analyses were performed on administrative data for injured patients, hospitalized in Belgium between 2009 and 2011 following a road traffic accident. Cases were matched to a control with similar injuries but without TBI. The incremental hospitalization cost of TBI and the factors contributing to the hospital costs were determined using multivariable regression modeling with gamma distribution and log link. Results: A descriptive comparison of cases and controls shows clear differences in healthcare utilization and costs. The presence of a TBI increases the cost by a factor between 1.66 (95% confidence interval: 1.52-1.82) and 2.08 (95% confidence interval: 1.72-2.51). Regarding healthcare utilization, the most important determinants of hospital costs are surgical complexity, use of magnetic resonance imaging, intensive care unit admission, and mechanical ventilation. Discussion: To our knowledge, this is the first matched-control study calculating the incremental hospitalization cost of TBI. The insights provided by this study are relevant in the context of prospective payments and can be an incentive for investments in prevention policies and extramural care.

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Superusers: Drivers of health care resource utilization in the national trauma population

Cited by 6 publications

References 14 publications

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Predictors of Trauma High Resource Consumers in a Mature Trauma System

The Incremental Hospitalization Cost of Significant Transport-Related Traumatic Brain Injury

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