Spending more on trauma care doesn’t improve survival, study finds

BMJ 2012; 345 doi: (Published 13 August 2012) Cite this as: BMJ 2012;345:e5471
  1. Janice Hopkins Tanne
  1. 1New York

Western US states spend a third more than northeastern states on trauma care, but survival rates are just the same, a new study says.1 It suggests that rising healthcare costs could be reined in if doctors learnt how colleagues in low cost regions treat their patients.

Wide geographical variations in care and costs for various conditions have previously been identified by the Dartmouth Health Atlas.2

The latest study, from the Johns Hopkins School of Medicine in Baltimore, was led by the trauma surgeon Adil Haider. Although initial trauma resuscitation has been significantly standardised across the United States, the study says that little is known about variations in cost and the savings that might be achieved.

The study looked at costs for five types of trauma among patients aged 18 to 64: blunt injury to the spleen, traumatic pneumothorax and haemothorax, tibia fracture, traumatic brain injury, and liver injury. It examined discharge records of 62 678 patients from the 2006-8 nationwide inpatient sample from the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. This is the largest all-payer inpatient care database that is publicly available in the US.

The median age of the patients was 41 to 43 (depending on region), and most were men (70% to 74%). Patients in the northeast were more likely to be in the highest income group, according to the postal code of their residence. Patients in the south were more likely to be in the lowest income group.

Costs were lowest in the northeast, although the region has generally high living costs and many major medical centres. The mean cost for all five conditions was $14 022 in the northeast. The relative cost ratios, with the northeast as the baseline, were 1.22 (95% confidence interval 1.14 to 1.31) in the midwest, 1.18 (1.1 to 1.27) in the south, and 1.33 (1.25 to 1.42) in the west. In all regions, patients were most likely to be covered by private insurance and to be treated in large hospitals. However, only in the west were they were most likely to be treated in non-teaching hospitals.

Although costs were lowest in the northeast, the length of stay was longest there, at 6.93 days, followed by the south, with 6.61 days, then the west (5.95 days) and the midwest (5.42 days).

Differences in the efficiency and the supply side of care, differences in patients’ health status, and profit driven care practices by doctors who may recommend discretionary interventions could explain some of the variations in cost, the authors say.

They wrote, “Our study on trauma care, which is essentially unpredictable, reduces the likelihood of some of the unmeasurable confounders that may be associated with studies involving patients with chronic conditions. Additionally, we focused this study on patients aged between 18 and 64 years, a group with fewer medical comorbidities [than patients aged 65 or over].” They suggest that “high-spending regions may potentially be able to curtail costs by adopting efficient strategies that are being used by the low-spending regions, without having to compromise quality.”


Cite this as: BMJ 2012;345:e5471


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