Patient-level resource use for injury admissions in Canada

A multicentre retrospective cohort study

Teegwendé V. Porgo, Lynne Moore, Catherine Truchon, Simon Berthelot, Henry T. Stelfox, Peter A. Cameron, Belinda J. Gabbe, Jeffrey S. Hoch, David C. Evans, François Lauzier, Francis Bernard, Alexis F. Turgeon, Julien Clément

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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 f 2 . 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 f 2 = 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% [4–6]), particularly for the OR (28% [20–40]). 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.

Original languageEnglish
Pages (from-to)1192-1201
Number of pages10
JournalInjury
Volume50
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Activity-based costing
  • Determinants
  • Inter-provider variations
  • Resource use intensity
  • Trauma

Cite this

Porgo, T. V., Moore, L., Truchon, C., Berthelot, S., Stelfox, H. T., Cameron, P. A., ... Clément, J. (2019). Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study. Injury, 50(6), 1192-1201. https://doi.org/10.1016/j.injury.2019.03.038
Porgo, Teegwendé V. ; Moore, Lynne ; Truchon, Catherine ; Berthelot, Simon ; Stelfox, Henry T. ; Cameron, Peter A. ; Gabbe, Belinda J. ; Hoch, Jeffrey S. ; Evans, David C. ; Lauzier, François ; Bernard, Francis ; Turgeon, Alexis F. ; Clément, Julien. / Patient-level resource use for injury admissions in Canada : A multicentre retrospective cohort study. In: Injury. 2019 ; Vol. 50, No. 6. pp. 1192-1201.
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title = "Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study",
abstract = "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 f 2 . 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 f 2 = 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{\%} [4–6]), particularly for the OR (28{\%} [20–40]). 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.",
keywords = "Activity-based costing, Determinants, Inter-provider variations, Resource use intensity, Trauma",
author = "Porgo, {Teegwend{\'e} V.} and Lynne Moore and Catherine Truchon and Simon Berthelot and Stelfox, {Henry T.} and Cameron, {Peter A.} and Gabbe, {Belinda J.} and Hoch, {Jeffrey S.} and Evans, {David C.} and Fran{\cc}ois Lauzier and Francis Bernard and Turgeon, {Alexis F.} and Julien Cl{\'e}ment",
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language = "English",
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Porgo, TV, Moore, L, Truchon, C, Berthelot, S, Stelfox, HT, Cameron, PA, Gabbe, BJ, Hoch, JS, Evans, DC, Lauzier, F, Bernard, F, Turgeon, AF & Clément, J 2019, 'Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study', Injury, vol. 50, no. 6, pp. 1192-1201. https://doi.org/10.1016/j.injury.2019.03.038

Patient-level resource use for injury admissions in Canada : A multicentre retrospective cohort study. / Porgo, Teegwendé V.; Moore, Lynne; Truchon, Catherine; Berthelot, Simon; Stelfox, Henry T.; Cameron, Peter A.; Gabbe, Belinda J.; Hoch, Jeffrey S.; Evans, David C.; Lauzier, François; Bernard, Francis; Turgeon, Alexis F.; Clément, Julien.

In: Injury, Vol. 50, No. 6, 06.2019, p. 1192-1201.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Patient-level resource use for injury admissions in Canada

T2 - A multicentre retrospective cohort study

AU - Porgo, Teegwendé V.

AU - Moore, Lynne

AU - Truchon, Catherine

AU - Berthelot, Simon

AU - Stelfox, Henry T.

AU - Cameron, Peter A.

AU - Gabbe, Belinda J.

AU - Hoch, Jeffrey S.

AU - Evans, David C.

AU - Lauzier, François

AU - Bernard, Francis

AU - Turgeon, Alexis F.

AU - Clément, Julien

PY - 2019/6

Y1 - 2019/6

N2 - 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 f 2 . 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 f 2 = 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% [4–6]), particularly for the OR (28% [20–40]). 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.

AB - 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 f 2 . 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 f 2 = 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% [4–6]), particularly for the OR (28% [20–40]). 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.

KW - Activity-based costing

KW - Determinants

KW - Inter-provider variations

KW - Resource use intensity

KW - Trauma

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U2 - 10.1016/j.injury.2019.03.038

DO - 10.1016/j.injury.2019.03.038

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