The Value of Trauma Center Care
The Value of Trauma Center Care
复制标题
DOI：
10.1097/ta.0b013e3181e03a21
复制
发表时间：
2010-07-01
影响因子：
--
通讯作者：
Salkever, David S.
中科院分区：
文献类型：
--
作者：
MacKenzie, Ellen J.;Weir, Sharada;Salkever, David S.
背景：创伤中心护理的成本很高，这引起了人们对创伤护理区域化方法价值的质疑。为了解决这些问题，我们估计1年和终身治疗费用，并衡量一级创伤中心（TC）与非创伤中心医院（NTC）相比治疗的成本效益。方法：成本效益的估计是根据参加国家创伤成本和结局研究的5,043名严重创伤患者的数据得出的，对14个州69家医院的严重受伤成年患者进行了前瞻性队列研究。成本数据来自多个来源，包括医疗保险和医疗补助服务中心的索赔数据，UB 92医院账单和患者访谈。成本效益估计为成本差异（TC与NTC治疗）除以获得的生命年（和挽救的生命）差异的比率。我们还测量了使用SF-6D测量生活质量时获得的每质量调整生命年的成本效益。我们使用逆概率的治疗加权调整在TC和NTCs.Results治疗的患者之间的可观察到的差异：在TC与NTC治疗的增加成本为36，319美元每生命年获得（790，931美元每挽救生命）和36，961美元每质量调整生命年获得。成本效益是更有利的患者与损伤的严重程度较高与较低，年轻与老年patients.Conclusions：我们的研究结果提供的证据表明，创伤护理的区域化不仅是有效的，而且它是具有成本效益的。
Background: The cost of trauma center care is high, raising questions about the value of a regionalized approach to trauma care. To address these concerns, we estimate 1-year and lifetime treatment costs and measure the cost-effectiveness of treatment at a Level I trauma center (TC) compared with a nontrauma center hospital (NTC).Methods: Estimates of cost-effectiveness were derived using data on 5,043 major trauma patients enrolled in the National Study on Costs and Outcomes of Trauma, a prospective cohort study of severely injured adult patients cared for in 69 hospitals in 14 states. Data on costs were derived from multiple sources including claims data from the Centers for Medicare and Medicaid Services, UB92 hospital bills, and patient interviews. Cost-effectiveness was estimated as the ratio of the difference in costs (for treatment at a TC vs. NTC) divided by the difference in life years gained (and lives saved). We also measured cost-effectiveness per quality-adjusted life year gained where quality of life was measured using the SF-6D. We used inverse probability of treatment weighting to adjust for observable differences between patients treated at TCs and NTCs.Results: The added cost for treatment at a TC versus NTC was $36,319 per life-year gained ($790,931 per life saved) and $36,961 per quality-adjusted life years gained. Cost-effectiveness was more favorable for patients with injuries of higher versus lower severity and for younger versus older patients.Conclusions: Our findings provide evidence that regionalization of trauma care is not only effective but also it is cost-effective.