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The Association Between Cost and Quality in Trauma: Is Greater Spending Associated With Higher-Quality Care?
Ann Surg. 2010 Jul 19;
Authors: Glance LG, Dick AW, Osler TM, Meredith W, Mukamel DB
OBJECTIVE:: To examine the association between trauma center quality and costs. BACKGROUND:: Current efforts to reduce health care costs and improve health care quality require a better understanding of the relationship between cost and quality. METHODS:: Using data from the Healthcare Cost and Utilization Projects Nationwide Inpatient Sample, we performed a retrospective observational study of 67,124 trauma patients admitted to 73 trauma centers. Generalized linear models were used to explore the association between hospital cost and in-hospital mortality, controlling for hospital and patient factors as follows: injury diagnoses, age, gender, mechanism of injury, comorbidities, teaching status, hospital ownership, geographic region, and hospital wages. RESULTS:: Patients treated in hospitals with low risk-adjusted mortality rates had significantly lower costs than those treated in average-quality hospitals. The relative cost of patients treated in high-quality hospitals was 0.78 (95% confidence interval: 0.64, 0.95) compared with average-quality hospitals. The cost of treating patients in average- and high-mortality trauma centers was similar. CONCLUSION:: In this study based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the care of injured patients is less expensive in hospitals with lower risk-adjusted mortality rates. Hospitals with low risk-adjusted mortality rates have adjusted mortality rates that are 34% lower while spending nearly 22% less compared with average-quality hospitals.
PMID: 20647927 [PubMed - as supplied by publisher]