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  • Title: The association between cost and quality in trauma: is greater spending associated with higher-quality care?
    Author: Glance LG, Dick AW, Osler TM, Meredith W, Mukamel DB.
    Journal: Ann Surg; 2010 Aug; 252(2):217-22. PubMed ID: 20647927.
    Abstract:
    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.
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