Traumatic differences

Even as protocols and procedures for trauma care have been widely standardized in recent years, the price tag for such care still varies considerably from one region of the U.S. to another.

That's according to a study published in the Journal of Trauma and Acute Care Surgery, which found that per-person trauma-care costs were generally lowest in the Northeast and highest in the West. Using three years of administrative discharge data from the Nationwide Inpatient Sample—part of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project—the authors analyzed overall trauma-care costs as well as average costs for five conditions, including liver injury, tibia fracture and moderate traumatic brain injury.

In the Northeast, the average per-person cost for trauma care was $14,022. That number was 35% higher in the West, 22% higher in the Midwest and 18% higher in the South. For traumatic brain injury, the difference was even larger, with average costs totaling $16,115 in the Northeast and $22,078 in the West—a difference of 37%.

“We were surprised at how much variation there was,” said Dr. Adil Haider, associate professor of surgery and health policy at Johns Hopkins University, Baltimore, and the study's lead author. “We expected trauma care might be a little more expensive in some regions, based on things like the consumer price index, but after controlling for those factors, we still found significant differences.”

Higher costs don't necessarily mean better outcomes, Haider said. Indeed, the authors found no significant difference in overall trauma-related mortality rates from region to region.

An earlier study, published in the August 2010 issue of the Annals of Surgery, actually found that higher-quality trauma care was associated with lower costs. Led by Dr. Laurent Glance, a professor and anesthesiologist at the University of Rochester (N.Y.) Medical Center, that study found that high-performing hospitals with lower mortality rates spent almost 22% less on trauma care than their average-performing counterparts.

It's still unclear why prices are so much higher in certain regions, Haider said. He pointed out that the study he led looked at differences in cost and mortality but not at patient-centered outcomes such as pain or mobility.

“Survival is important, but we still don't know whether hospitals with higher trauma costs are providing better care,” he said. “Maybe they are spending more money, but their patients are able to walk or go back to work sooner. We just don't know.”

Researchers also don't know for sure what hospitals in high-performing, low-cost areas are doing right to keep their spending levels down, Haider said. For instance, practice utilization patterns might differ across regions or hospital competition in one area might keep prices lower.

Unknowns such as those highlight the need for more comparative-effectiveness research focused specifically on trauma care, Haider added.

The work of the Patient-Centered Outcomes Research Institute, an independent, not-for-profit organization established by the healthcare reform law to fund and promote such research, marks a good first step, Haider said, but he argues that more needs to be done.

“Trauma is still one of the least-funded research specialties even though it's the number one cause of death for younger people,” he said. “We need research that shows us what works and what doesn't. Research like that gives us clues about how to bend the cost curve and it also shows us what's best for our patients.”