The variation of acute treatment costs of trauma in high-income countries

Willenberg, L.; Curtis, Kate; Taylor, Colman; Jan, Stephen; Glass, Parisa; Myburgh, John

doi:10.1186/1472-6963-12-267

Cited by 37 publications

(22 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Average per patient costs for severely injured patients in this study were less than those reported internationally 7 and locally. 28 In comparing costs, it is necessary to collect data across multiple sites so that discrepancies caused by variations in efficiency across centres are offset.…”

Section: Discussioncontrasting

confidence: 40%

“…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%

See 1 more Smart Citation

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

Curtis

Lam²,

Mitchell³

et al. 2014

Aust. Health Review

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 40%

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…During the study period, a HEMS pre-hospital and inter-hospital patient cost, on average, ~$25,000 and ~$42,000 respectively to treat, although considerable variation existed between patients, which has also been demonstrated previously [27]. Our results show HEMS patients are potentially underfunded in the order of ~$2,500 - ~$2,900 per patient transported pre-hospital and inter-hospital respectively.…”

Section: Discussionsupporting

confidence: 80%

Helicopter Emergency Medical Services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundIn NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW.MethodsThe study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS≤12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies.ResultsA total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage.ConclusionsHEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of transport performed. Although severely injured HEMS patients are more costly to treat, HEMS patients with minor injuries make up the majority of HEMS transports and have larger relative potential funding discrepancies. Future episode funding models need to account for the variability of trauma patients and the proportion of patients transported via HEMS.

show abstract

“…probably due to a different pattern in productivity costs among age categories. Other variables such as high ISS, specific body regions (abdomen, spine and brain injury) and LOS were also identified as prognostic factors for medical costs in a review [38].…”

Section: Plos Onementioning

confidence: 99%

Prognostic factors for medical and productivity costs, and return to work after trauma

et al. 2020

View full text Add to dashboard Cite

The aim of this study was to determine prognostic factors for medical and productivity costs, and return to work (RTW) during the first two years after trauma in a clinical trauma population. Methods This prospective multicentre observational study followed all adult trauma patients (�18 years) admitted to a hospital in Noord-Brabant, the Netherlands from August 2015 through November 2016. Health care consumption, productivity loss and return to work were measured in questionnaires at 1 week, 1, 3, 6, 12 and 24 months after injury. Data was linked with hospital registries. Prognostic factors for medical costs and productivity costs were analysed with log-linked gamma generalized linear models. Prognostic factors for RTW were assessed with Cox proportional hazards model. The predictive ability of the models was assessed with McFadden R 2 (explained variance) and c-statistics (discrimination). Results A total of 3785 trauma patients (39% of total study population) responded to at least one follow-up questionnaire. Mean medical costs per patient (€9,710) and mean productivity costs per patient (€9,000) varied widely. Prognostic factors for high medical costs were higher age, female gender, spine injury, lower extremity injury, severe head injury, high injury severity, comorbidities, and pre-injury health status. Productivity costs were highest in males, and in patients with spinal cord injury, high injury severity, longer length of stay at the hospital and patients admitted to the ICU. Prognostic factors for RTW were high educational level, male gender, low injury severity, shorter length of stay at the hospital and absence of comorbidity.

show abstract

The variation of acute treatment costs of trauma in high-income countries

Cited by 37 publications

References 43 publications

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

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

Helicopter Emergency Medical Services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia

Prognostic factors for medical and productivity costs, and return to work after trauma

Contact Info

Product

Resources

About