Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
Injury. 2019 Jun;50(6):1192-1201. doi: 10.1016/j.injury.2019.03.038. Epub 2019 Mar 28.
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.
To estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.
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. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.
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 = 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]).
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.
在美国，创伤中心之间的调整后成本存在差异，但成本较高的中心并未带来更好的患者预后。由于缺乏关于资源使用和资源使用强度驱动因素的患者层面信息，改进创伤护理效率的尝试受到阻碍。
估计创伤入院患者的资源使用情况，确定资源使用强度的决定因素，并评估医院间资源使用的差异。
我们进行了一项回顾性队列研究，纳入了 2014 年至 2016 年期间在一个成熟、包容的加拿大创伤系统中成年创伤中心接受治疗的 16 岁及以上患者。我们从创伤登记处和医院财务报告中提取数据。我们使用基于活动的成本来估计资源使用情况，使用多水平线性模型确定资源使用强度的决定因素，并使用科恩氏 f 评估每个决定因素的相对重要性。我们使用组内相关系数（ICC）和 95%置信区间评估提供者间的差异。
我们纳入了 32411 名患者。每位患者的平均住院费用为 4857 加元（四分位距 1 和 3 为 2961-8448）。总资源使用的最重要贡献者是医疗病房（57%），其次是手术室（OR；23%）和重症监护病房（13%）。资源使用强度的最强决定因素是出院去向（科恩氏 f = 7%）。资源使用最密集的患者群体是脊髓损伤患者，每位患者的费用为 11193 加元（7115-17606）。对于医疗病房，资源使用随着年龄的增加而增加，但对于 OR，资源使用随着年龄的增加而减少。I 级中心的资源使用量比 IV 级中心高 18%，并且我们观察到中心之间的资源使用存在显著差异（ICC = 5% [4-6]），特别是对于 OR（28% [20-40]）。
魁北克省急性创伤护理的资源使用不仅仅是由于患者的临床状况。我们确定了资源使用的决定因素，可用于制定基于证据的资源分配和提高创伤护理效率。我们为估计创伤入院患者的医院内资源使用情况和确定相关决定因素而开发的方法，可以使用当地创伤登记处数据和我们的单位成本或特定于每个环境的单位成本进行复制。
