PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 1996 April; 31(1): 71–95.
PMCID: PMC1070104

Trauma systems and the costs of trauma care.

Abstract

OBJECTIVE. This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. DATA SOURCES AND STUDY SETTING. Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. STUDY DESIGN. Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. DATA COLLECTION/EXTRACTION METHODS. Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. PRINCIPAL FINDINGS. The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. CONCLUSIONS. Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this level and/or reconsidering the requirements placed on these centers.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Baker SP, O'Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed]
  • Baxt WG, Upenieks V. The lack of full correlation between the Injury Severity Score and the resource needs of injured patients. Ann Emerg Med. 1990 Dec;19(12):1396–1400. [PubMed]
  • Bazzoli GJ, MacKenzie EJ. Trauma centers in the United States: identification and examination of key characteristics. J Trauma. 1995 Jan;38(1):103–110. [PubMed]
  • Bazzoli GJ, Madura KJ, Cooper GF, MacKenzie EJ, Maier RV. Progress in the development of trauma systems in the United States. Results of a national survey. JAMA. 1995 Feb 1;273(5):395–401. [PubMed]
  • Cales RH. Trauma mortality in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med. 1984 Jan;13(1):1–10. [PubMed]
  • Cales RH, Trunkey DD. Preventable trauma deaths. A review of trauma care systems development. JAMA. 1985 Aug 23;254(8):1059–1063. [PubMed]
  • Champion HR, Gainer PS, Yackee E. A progress report on the trauma score in predicting a fatal outcome. J Trauma. 1986 Oct;26(10):927–931. [PubMed]
  • Coffey RM, Goldfarb MG. DRGs and disease staging for reimbursing Medicare patients. Med Care. 1986 Sep;24(9):814–829. [PubMed]
  • Cooper MA, Borst C, Flint L, Thomas D. Financial analysis of an inner city trauma center: charges vs collections. Ann Emerg Med. 1985 Apr;14(4):331–334. [PubMed]
  • Fischer RP, Flynn TC, Miller PW, Rowlands BJ. The economics of fatal injury: dollars and sense. J Trauma. 1985 Aug;25(8):746–750. [PubMed]
  • Gonnella JS, Hornbrook MC, Louis DZ. Staging of disease. A case-mix measurement. JAMA. 1984 Feb 3;251(5):637–644. [PubMed]
  • Guss DA, Meyer FT, Neuman TS, Baxt WG, Dunford JV, Jr, Griffith LD, Guber SL. The impact of a regionalized trauma system on trauma care in San Diego County. Ann Emerg Med. 1989 Nov;18(11):1141–1145. [PubMed]
  • MacKenzie EJ, Morris JA, Jr, Edelstein SL. Effect of pre-existing disease on length of hospital stay in trauma patients. J Trauma. 1989 Jun;29(6):757–765. [PubMed]
  • MacKenzie EJ, Shapiro S, Siegel JH. The economic impact of traumatic injuries. One-year treatment-related expenditures. JAMA. 1988 Dec 9;260(22):3290–3296. [PubMed]
  • MacKenzie EJ, Steinwachs DM, Ramzy AI. Evaluating performance of statewide regionalized systems of trauma care. J Trauma. 1990 Jun;30(6):681–688. [PubMed]
  • MacKenzie EJ, Steinwachs DM, Ramzy AI, Ashworth JW, 3rd, Shankar B. Trauma case mix and hospital payment: the potential for refining DRGs. Health Serv Res. 1991 Apr;26(1):5–26. [PMC free article] [PubMed]
  • 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 Apr;27(4):412–422. [PubMed]
  • Mendeloff JM, Cayten CG. Trauma systems and public policy. Annu Rev Public Health. 1991;12:401–424. [PubMed]
  • Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma. 1986 Sep;26(9):812–820. [PubMed]
  • Smith JS, Jr, Martin LF, Young WW, Macioce DP. Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories. J Trauma. 1990 Dec;30(12):1533–1538. [PubMed]
  • West JG, Cales RH, Gazzaniga AB. Impact of regionalization. The Orange County experience. Arch Surg. 1983 Jun;118(6):740–744. [PubMed]
  • Young WW, Macioce DP. PMCs--an alternative to DRGs for trauma care reimbursement. J Trauma. 1991 Apr;31(4):459–470. [PubMed]
  • Young JC, Macioce DP, Young WW. Identifying injuries and trauma severity in large databases. J Trauma. 1990 Oct;30(10):1220–1230. [PubMed]
  • Young WW, Young JC, Smith JS, Rhodes M. Defining the major trauma patient and trauma severity. J Trauma. 1991 Aug;31(8):1125–1141. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust