Evaluation of the association between hospital resource use intensity and quality of care in a trauma system

PI: Lynne Moore

Co-Is: Alexis F. Turgeon, François Lauzier, Francis Bernard, Simon Berthelot, François Lamontagne, Tarek Razek

In 2010, preventable injuries led to 53,000 hospitalizations, 14,000 permanent disabilities and 3,440 deaths in the province of Québec with associated costs of over $5.7 billion. Preventable injury is second only to cardiovascular diseases in terms of acute care costs with enormous potential for improvements in efficiency. Unnecessary delays, tests and procedures represent the most important areas of excess healthcare spending and increase patient exposure to infections, adverse events and functional decline. To reduce this inappropriate use of scarce resources, we need to improve our understanding of injury care resource use and of the association between resource use and quality of care. We have demonstrated that patient-level data on injury costs in universal health systems is limited to one European study. Furthermore, according to a recent systematic review, studies on the association between resource use and quality of care conducted to date are largely limited to chronic disease admissions, have not adequately adjusted for patient health status, have evaluated only one element of quality (usually mortality), have not broken down the association by areas of resource use and have not accounted for nonlinear or bidirectional associations. In direct response to this knowledge gap, the overarching goal of this project is to identify aspects of resource use intensity that drive high quality care and those with no clinical benefit to inform improvements in acute injury care effectiveness and efficiency. We will conduct a multicenter retrospective cohort study based on the Québec trauma system (2000-2013, 190,000 patients, 57 hospitals). Specific objectives are to:

1. Estimate patient-level costs associated with acute injury care and identify determinants;
2. Derive and validate a hospital indicator of resource use intensity based on risk-adjusted mean costs; and
3. Evaluate the multifactorial association between resource use intensity and injury care quality.

In the short term, the resource use indicator will be integrated into the Québec Trauma Care Continuum. Our results will be directly disseminated to local trauma committees, hospital administrators and the Ministry of Health in collaboration with INESSS  via a Web platform which is already in place. For hospitals with high resource use but average or below average quality of care, our results will be used to identify the root cause of the problem (e.g. activity center, type of injury) and to plan interventions to better standardize injury care resource use in the trauma system.

In the medium term, the indicator will be adapted to comparisons of injury care resource use intensity across Canadian provinces in collaboration with the Trauma Association of Canada and Accreditation Canada and to international comparisons in collaboration with the American College of Surgeons and the International Initiative for injury care improvements. It will also be adapted to resource use evaluations in other health care sectors in collaboration with INESSS. This project will improve the effectiveness and efficiency of acute injury care. It has the potential to reduce costs, increase the availability of scarce resources, and improve outcomes for patients hospitalized following injury in Québec and across Canada.