The cost of overtriage: More than one-third of low-risk injured patients were taken to major trauma centers

Health Affairs

Volumn 32, Issue 9, 2013, Pages 1591-1599

  Newgard, Craig D ^a   Staudenmayer, Kristan ^b   Hsia, Renee Y ^c   Mann, N Clay ^d   Bulger, Eileen M ^e   Holmes, James F ^f   Fleischman, Ross ^g   Gorman, Kyle ^h   Haukoos, Jason ⁱ   McConnell, K John ^a  

^a OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

^b STANFORD UNIVERSITY   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d UNIVERSITY OF UTAH   (United States)

^e UNIVERSITY OF WASHINGTON   (United States)

^f UNIVERSITY OF CALIFORNIA   (United States)

^g HARBOR UCLA MEDICAL CENTER   (United States)

^h Clackamas County Fire District No 1   (United States)

ⁱ DENVER HEALTH MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCOUNTING; ADULT; ARTICLE; ASSAULT; COHORT ANALYSIS; COST CONTROL; EMERGENCY CARE; EMERGENCY HEALTH SERVICE; FEMALE; FOLLOW UP; GUNSHOT INJURY; HEALTH CARE COST; HEALTH CARE FACILITY; HOSPITAL CHARGE; HUMAN; INJURY; INJURY SEVERITY; LOW RISK POPULATION; MAJOR CLINICAL STUDY; MALE; PATIENT TRANSPORT; PRACTICE GUIDELINE; RETROSPECTIVE STUDY; STAB WOUND; TRAFFIC ACCIDENT;

CLINICAL ISSUES; COST OF HEALTH CARE; EMERGENCY CARE; EPIDEMIOLOGY; HOSPITALS; ORGANIZATION AND DELIVERY OF CARE;

ADOLESCENT; ADULT; COSTS AND COST ANALYSIS; HUMANS; INJURY SEVERITY SCORE; MIDDLE AGED; SENSITIVITY AND SPECIFICITY; TRAUMA CENTERS; TRIAGE; UNITED STATES; WOUNDS AND INJURIES; YOUNG ADULT;

EID: 84885336179     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.1142     Document Type: Article

References (41)

1. Thorpe KE, Florence CS, Joski P. Which medical conditions account for the rise in health care spending? Health Aff (Millwood). 2004;23(4): w4-437-45. DOI: 10.1377/hlthaff .w4.437.
2. Weir S, Salkever DS, Rivara FP, Jurkovich GJ, Nathens AB, Mackenzie EJ. One-year treatment costs of trauma care in the USA. Expert Rev Pharmacoecon Outcomes Res. 2010;10(2):187-97.
3. Centers for Disease Control and Prevention. Medical expenditures attributable to injuries-United States, 2000. MMWR Morb Mortal Wkly Rep. 2004;53(1):1-4.
4. Mann NC, Mackenzie E, Teitelbaum SD, Wright D, Anderson C. Trauma system structure and viability in the current healthcare environment: a state-by-state assessment. J Trauma. 2005;58(1):136-47.
5. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006; 354(4):366-78.
6. Mullins RJ, Veum-Stone J, Helfand M, Zimmer-Gembeck M, Hedges JR, Southard PA, et al. Outcome of hospitalized injured patients after institution of a trauma system in an urban area. JAMA. 1994;271(24): 1919-24.
7. Sampalis JS, Denis R, Lavoie A, Fréchette P, Boukas S, Nikolis A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma. 1999;46(4):565-79; discussion 579-81.
8. Pracht EE, Tepas JJ 3rd, Celso BG, Langland-Orban B, Flint L. Survival advantage associated with treatment of injury at designated trauma centers: a bivariate probit model with instrumental variables. Med Care Res Rev. 2007;64(1):83-97.
9. Nathens AB, Jurkovich GJ, Rivara FP, Maier RV. Effectiveness of state trauma systems in reducing injuryrelated mortality: a national evaluation. J Trauma. 2000;48:25-30.
10. Cooper A, Barlow B, DiScala C, String D, Ray K, Mottley L. Efficacy of pediatric trauma care: results of a population-based study. J Pediatr Surg. 1993;28(3):299-303.
11. Hulka F, Mullins RJ, Mann NC, Hedges JR, Rowland D,Worrall WH, et al. Influence of a statewide trauma system on pediatric hospitalization and outcome. J Trauma. 1997;42(3): 514-9.
12. Pracht EE, Tepas JJ 3rd, Langland- Orban B, Simpson L, Pieper P, Flint LM. Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers? J Pediatr Surg. 2008;43(1):212-21.
13. MacKenzie EJ, Weir S, Rivara FP, Jurkovich GJ, Nathens AB, Wang W, et al. The value of trauma center care. J Trauma. 2010;69:1-9.
14. Goldfarb MG, Bazzoli GJ, Coffey RM. Trauma systems and the costs of trauma care. Health Serv Res. 1996; 31(1):71-95.
15. Durham R, Pracht E, Orban B, Lottenburg L, Tepas J, Flint L. Evaluation of a mature trauma system. Ann Surg. 2006;243(6):775-83.
16. Mackersie RC. History of trauma field triage development and the American College of Surgeons criteria. Prehosp Emerg Care. 2006; 10(3):287-94.
17. Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1-20.
18. American College of Surgeons. Resources for the optimal care of the injured patient. Chicago (IL): ACS; 2006.
19. Newgard CD, Hsia RY, Mann NC, Schmidt T, Sahni R, Bulger EM, et al. The trade-offs in field trauma triage: a multiregion assessment of accuracy metrics and volume shifts associated with different triage strategies. J Trauma Acute Care Surg. 2013; 74(5):1298-306.
20. Newgard CD, Nelson MJ, Kampp M, Saha S, Zive D, Schmidt T, et al. Outof- hospital decision making and factors influencing the regional distribution of injured patients in a trauma system. J Trauma. 2011; 70(6):1345-53.
21. Newgard CD, Mann NC, Hsia RY, Bulger EM, Ma OJ, Staudenmayer K, et al. Patient choice in the selection of hospitals by 911 emergency medical services providers in trauma systems. Acad Emerg Med. Forthcoming.
22. Newgard C, Malveau S, Staudenmayer K,Wang NE, Hsia RY, Mann NC, et al. Evaluating the use of existing data sources, probabilistic linkage, and multiple imputation to build population-based injury databases across phases of trauma care. Acad Emerg Med. 2012;19(4): 469-80.
23. Newgard CD, Zive D, Jui J,Weathers C, Daya M. Electronic versus manual data processing: evaluating the use of electronic health records in out-ofhospital clinical research. Acad Emerg Med. 2012;19(2):217-27.
24. Newgard CD. Validation of probabilistic linkage to match de-identified ambulance records to a state trauma registry. Acad Emerg Med. 2006;13; 69-75.
25. To access the Appendix, click on the Appendix link in the box to the right of the article online.
26. Clark DE, Osler TM, Hahn DR. ICDPIC: Stata module to provide methods for translating International Classification of Diseases (Ninth Revision) diagnosis codes into standard injury categories and/or scores. Boston (MA): Boston College Department of Economics; 2009.
27. Baker SP, O'Neill B, Haddon W Jr., Long WB. The Injury Severity Score: a method for describing patients withmultiple injuries and evaluating emergency care. J Trauma. 1974; 14(3):187-96.
28. MacKenzie EJ, Steinwachs DM, Shankar BS, Turney SZ. An ICD-9CM to AIS conversion table: development and application. Proc AAAM. 1986;30:135-51.
29. MacKenzie EJ, Steinwachs DM, Shankar B. Classifying trauma severity based on hospital discharge diagnoses. Validation of an ICD-9CM to AIS-85 conversion table. Med Care. 1989;27:412-22.
30. Fleischman RJ, Mann NC, Wang NE, Hsia RY, Rea TD, Liao M, et al. Society for Academic Emergency Medicine Annual Meeting Abstracts- 2012: validating the use of ICD9 codes to generate injury severity score: the ICDPIC mapping procedure. Acad Emerg Med. 2012;19(Suppl 1):S4-393.
31. Bazzoli GJ, Kang R, Hasnain-Wynia R, Lindrooth RC. An update on safety-net hospitals: coping with the late 1990s and early 2000s. Health Aff (Millwood). 2005;24(4): 1047-56.
32. Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and lifetime costs of injuries in the United States. Inj Prev. 2006;12(4): 212-8.
33. Bureau of Labor Statistics. Consumer Price Index [Internet]. Washington (DC): Department of Labor; [cited 2013 Jul 19]. Available from: http://www.bls.gov/cpi/
34. Rubin DB. Multiple imputation for nonresponse in surveys. New York (NY): John Wiley and Sons, Inc.; 1987.
35. Raghunathan T, Lepkowski JM, Van Hoewyk J, Solenberger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol. 2001;27:85-95.
36. Manning WG. The logged dependent variable, heteroscedasticity, and the retransformation problem. J Health Econ. 1998;17:283-95.
37. Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20: 461-94.
38. Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005;24: 465-88.
39. Taylor CB, Stevenson M, Jan S, Middleton PM, Fitzharris M, Myburgh JA. A systematic review of the costs and benefits of helicopter emergency medical services. Injury. 2010;41(1):10-20.
40. McConnell KJ, Johnson LA, Arab N, Richards CF, Newgard CD, Edlund T. The on-call crisis: a statewide assessment of the costs of providing on-call specialist coverage. Ann Emerg Med. 2007;49:727-33.
41. Faul M, Wald MM, Sullivent EE, Sasser SM, Kapil V, Lerner EB, et al. Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers. Prehosp Emerg Care. 2012;16(2):222-9.