La trilogía del enfermerode práctica avanzada paramejorar la efectividaden las heridas crónicas en elDistrito Sanitario Almería / The trilogy of the advanced practice nurse to improve the effectiveness in chronic wounds in Almeria Health District

Objetivos: Analizar el concepto coste-efectividad sobre el registro de heridas, así como acerca del consumo de apósitos prescritos desde la aplicación informática Diraya tras la formación realizada en heridas durante el año 2022 por el enfermero de práctica avanzada en heridas crónicas complejas (EPA-HCC) en el Distrito Sanitario Almería (DSA). Metodología: Estudio descriptivo, retrospectivo desde el 1 de enero al 31 de diciembre del año 2022, analizando en 2 semestres los costes económicos en consumo de apósitos. Resultados: En el año 2022 se formaron un total de 604 enfermeras en heridas, de las cuales 579 fueron formadas por el EPA-HCC del DSA en el segundo semestre. Tras esta formación se realizó un total de 15.648 registros, por lo que en el registro se produjo un incremento del porcentaje del 18,08% durante el segundo semestre y se obtuvo un ahorro económico de 63.049 € (–24,73%) entre los años 2021 y 2022, mientras que la estimación durante el segundo semestre fue de –73.982 €. Conclusiones: La formación realizada por el EPA-HCC mejora los conocimientos de los profesionales, incrementa los registros y consigue una optimización de los recursos.(AU)

Objectives: To analyze the cost-effectiveness concept of wound registry, as well as the consumption of dressings prescribed from the Diraya computer application after the training carried out in wounds during the year 2022 by the advanced practice nurse in complex chronic wounds (EPA-HCC) in Distrito Sanitario Almería (DSA). Methodology: Retrospective descriptive study from January 1 to December 31, 2022, analyzing in two semesters the economic costs in dressing consumption. Results: A total of 604 wound nurses were trained in 2022, of which 579 were trained by the EPA-HCC of DSA in the second semester. After this training, a total of 15,648 registrations were made, resulting in a percentage increase in registration in the second semester of 18.08%, obtaining an economic saving of 63,049 € (–24.73%) obtained between the years 2021 and 2022, while the estimate saving in the second semester was –73,982 €. Conclusions: The training carried out by the EPA-HCC improves the knowledge of professionals, increases registrations and achieves an optimization of resources.(AU)

Costs and Survival of Patients having Experienced a Hospitalized Fall-Related Injury in France: A Population-Based Study.

OBJECTIVES: To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old. DESIGN: We performed a population-based, retrospective cohort study using the French national health insurance claims database. SETTING AND PARTICIPANTS: Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted. METHODS: Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities. RESULTS: A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs. CONCLUSIONS AND IMPLICATIONS: We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.

Hospitalization costs of injury in elderly population in China: a quantile regression analysis.

BACKGROUND: Trauma in the elderly is gradually growing more prevalent as the aging population increases over time. The purpose of this study is to assess hospitalization costs of the elderly trauma population and analyze the association between those costs and the features of the elderly trauma population. METHODS: In a retrospective analysis, data on trauma patients over 65 who were admitted to the hospital for the first time due to trauma between January 2017 and March 2022 was collected from a tertiary comprehensive hospital in Baotou. We calculated and analyzed the hospitalization cost components. According to various therapeutic approaches, trauma patients were divided into two subgroups: non-surgical patients (1320 cases) and surgical patients (387 cases). Quantile regression was used to evaluate the relationship between trauma patients and hospitalization costs. RESULTS: This study comprised 1707 trauma patients in total. Mean total hospitalization costs per patient were ¥20,741. Patients with transportation accidents incurred the highest expenditures among those with external causes of trauma, with a mean hospitalization cost of ¥24,918, followed by patients with falls at ¥19,809 on average. Hospitalization costs were dominated by medicine costs (¥7,182 per capita). According to the quantile regression results, all trauma patients' hospitalization costs were considerably increased by length of stay, surgery, the injury severity score (16-24), multimorbidity, thorax injury, and blood transfusion. For non-surgical patients, length of stay, multimorbidity, and the injury severity score (16-24) were all substantially linked to higher hospitalization costs. For surgical patients, length of stay, injury severity score (16-24), and hip and thigh injuries were significantly associated with greater hospitalization costs. CONCLUSIONS: Using quantile regression to identify factors associated with hospitalization costs could be helpful for addressing the burden of injury in the elderly population. Policymakers may find these findings to be insightful in lowering hospitalization costs related to injury in the elderly population.

Health Benefits of Strategies for Carbon Mitigation in US Transportation, 2017‒2050.

Objectives. To quantify health benefits and carbon emissions of 2 transportation scenarios that contrast optimum levels of physical activity from active travel and minimal air pollution from electric cars. Methods. We used data on burden of disease, travel, and vehicle emissions in the US population and a health impact model to assess health benefits and harms of physical activity from transportation-related walking and cycling, fine particulate pollution from car emissions, and road traffic injuries. We compared baseline travel with walking and cycling a median of 150 weekly minutes for physical activity, and with electric cars that minimized carbon pollution and fine particulates. Results. In 2050, the target year for carbon neutrality, the active travel scenario avoided 167 000 deaths and gained 2.5 million disability-adjusted life years, monetized at $1.6 trillion using the value of a statistical life. Carbon emissions were reduced by 24% from baseline. Electric cars avoided 1400 deaths and gained 16 400 disability-adjusted life years, monetized at $13 billion. Conclusions. To achieve carbon neutrality in transportation and maximize health benefits, active travel should have a prominent role along with electric vehicles in national blueprints. (Am J Public Health. 2022; 112(3):426-433. https://doi.org/10.2105/AJPH.2021.306600).

Pediatric Traumatic Injury Emergency Department Visits and Management in US Children's Hospitals From 2010 to 2019.

STUDY OBJECTIVE: To examine trends in trauma-related pediatric emergency department (ED) visits and management in US children's hospitals over 10 years. METHODS: This is a retrospective, descriptive study of the Pediatric Health Information Systems database, including encounters from 33 US children's hospitals. We included patients aged 0 to 19 years with traumatic injuries from 2010 to 2019 identified using International Classification of Diseases-9 and -10 codes. The primary outcome was prevalence of trauma-related ED visits. The secondary outcomes included ED disposition, advanced imaging use, and trauma care costs. We examined trends over time with Poisson regression models, reporting incidence rate ratios (IRRs) with 95% confidence intervals (CIs). We compared demographic groups with rate differences with 95% CIs. RESULTS: Trauma-related visits accounted for 367,072 ED visits (16.3%) in 2010 and 479,458 ED visits (18.1%) in 2019 (IRR 1.022, 95% CI 1.018 to 1.026). From 2010 to 2019, 54.6% of children with traumatic injuries belonged to White race and 23.9% had Hispanic ethnicity. Institutional hospitalization rates (range 3.8% to 14.9%) decreased over time (IRR 0.986, 95% CI 0.977 to 0.994). Hospitalizations from 2010 to 2019 were higher in White children (8.9%) than in children of other races (6.4%) (rate difference 2.56, 95% CI 2.51 to 2.61). Magnetic resonance imaging for brain (IRR 1.05, 95% CI 1.04 to 1.07) and cervical spine (IRR 1.03, 95% CI 1.02 to 1.05) evaluation increased. The total trauma care costs were $6.7 billion, with median costs decreasing over time. CONCLUSION: During the study period, pediatric ED visits for traumatic injuries increased, whereas hospitalizations decreased. Some advanced imaging use increased; however, median trauma costs decreased over time.

The actual, long-term cost of intentional injury care among a cohort of Maryland Medicaid recipients.

BACKGROUND: Intentional injury (both self-harm and interpersonal) is a major cause of morbidity and mortality, yet there are little data on the per-person cost of caring for these patients. Extant data focus on hospital charges related to the initial admission but does not include actual dollars spent or follow-up outpatient care. The Affordable Care Act has made Medicaid the primary payor of intentional injury care (39%) in the United States and the ideal source of cost data for these patients. We sought to determine the total and per-person long-term cost (initial event and following 24 months) of intentional injury among Maryland Medicaid recipients. METHODS: Retrospective cohort study of Maryland Medicaid claims was performed. Recipients who submitted claims after receiving an intentional injury, as defined by the International Classification of Diseases, Tenth Revision, between October 2015 and October 2017, were included in this study. Subjects were followed for 24 months (last participant enrolled October 2017 and followed to October 2019). Our primary outcome was the dollars paid by Medicaid. We examined subgroups of patients who harmed themselves and those who received repeated intentional injury. RESULTS: Maryland Medicaid paid $11,757,083 for the care of 12,172 recipients of intentional injuries between 2015 and 2019. The per-person, 2-year health care cost of an intentional injury was a median of $183 (SD, $5,284). These costs were highly skewed: min, $2.56; Q1 = 117.60, median, $182.80; Q3 = $480.82; and max, $332,394.20. The top 5% (≥95% percentile) required $3,000 (SD, $6,973) during the initial event and $8,403 (SD, $22,024) per served month thereafter, or 55% of the overall costs in this study. CONCLUSION: The long-term, per-person cost of intentional injury can be high. Private insurers were not included and may experience different costs in other states. LEVEL OF EVIDENCE: Economic and Value Based Evaluations; level III.

Financial Burden of Traumatic Injury Amongst the Privately Insured.

OBJECTIVE: We sought to evaluate the overall financial burden associated with traumatic injury amongst patients with private insurance and assess the effect of high deductible plans on out-of-pocket costs (OOPCs). SUMMARY OF BACKGROUND DATA: Traumatic injury can be a source of unexpected financial burden for households. However, the effect of increasing participation in higher cost-sharing private health insurance plans remains unknown. METHODS: We conducted a retrospective cohort observational study, using the Clinformatics Data Mart Database, a nationwide single-payer administrative claims database to identify US adults who required emergency department services or hospital admission for single traumatic injury from 2008 to 2018. A 2-part model using a logistic regression and a generalized linear model with gamma distribution and log link was used to evaluate 12-month OOPCs after traumatic injury. Multivariable logistic regression was used to evaluate the likelihood of catastrophic health expenditure (CHE) after injury. RESULTS: Of 426,945 included patients, 53% were male, 71% were white, and median age was 42 years. Patients faced monthly OOPC of $660 at the time of their injury. High deductible plan enrollment was associated with an increase of $1703 in 12-month OOPC after trauma, compared to those covered by traditional health plans. In addition to high deductible health plan enrollment, worsening injury severity and longer hospital stays were also associated with increased 12-month OOPC after trauma. Non-white minorities paid less 12-month OOPC after trauma compared to non-Hispanic white patients, but also used fewer services. Overall, the incidence of CHE was 5%; however high-deductible health plan enrollees faced a 13% chance of CHE. CONCLUSIONS: Privately insured trauma patients face substantial OOPCs at the time of their injuries. High-deductible health plans are associated with increased financial vulnerability after trauma.

Three months in a high-volume tertiary orthopaedic trauma unit: What is a registrar worth?

BACKGROUND: South Africa has a high burden of traumatic injuries that is predominantly managed in the public healthcare system, despite the relative disparity in human resources between the public and private sectors. Because of budget and theatre time constraints, the trauma waiting list often exceeds 50 - 60 patients who need urgent and emergent surgery in high-volume orthopaedic trauma centres. This situation is exacerbated by other surgical disciplines using orthopaedic theatre time for life-threatening injuries because of lack of own theatre availability. One of the proposed solutions to this problem is outsourcing of some of the cases to private medical facilities. OBJECTIVES: To establish the volume of work done by an orthopaedic registrar during a 3-month trauma rotation, and to calculate the implant and theatre costs, as well as compare the salary of a registrar with the theoretical private surgeon fees for procedures performed by the registrar in the 3-month period. METHODS: In a retrospective study, the surgical logbook of a single registrar during a 3-month rotation, from 14 January to 14 April 2019, was reviewed. Surgeon fees were calculated for these procedures, according to current medical aid rates, without additional modifier codes being added. RESULTS: During the 3-month study period, a total of 157 surgical procedures was performed, ranging from total hip arthroplasty to debridement of septic hands. Surgeon fees amounted to ZAR186 565.10 per month ‒ double the gross salary of a registrar. Total implant costs amounted to ZAR1 272 667. Theatre costs were ZAR1 301 976 for the 3-month period. CONCLUSIONS: Although this analysis was conducted over a short period, it highlights the significant amount of trauma work done by a single individual at a high-volume tertiary orthopaedic trauma unit. With increasing budget constraints, pressure on theatre time and a growing population, cost-effective expansion of resources is needed. From this study, it appears that increasing capacity in the state sector could be cheaper than private outsourcing, although a more in-depth analysis needs to be conducted.

State-Level Economic Costs of Fatal Injuries - United States, 2019.

Unintentional and violence-related injury fatalities, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the 10 leading causes of death for all age groups in the United States in 2019.* There were 246,041 injury deaths in 2019 (unintentional injury was the most frequent cause of death after heart disease and cancer) with an economic cost of $2.2 trillion (1). Extending a national analysis (1), CDC examined state-level economic costs of fatal injuries based on medical care costs and the value of statistical life assigned to 2019 injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).† West Virginia had the highest per capita cost ($11,274) from fatal injury, more than twice that of New York, the state with the lowest cost ($4,538). The five areas with the highest per capita total fatal injury costs were West Virginia, New Mexico, Alaska, District of Columbia (DC), and Louisiana; costs were lowest in New York, California, Minnesota, Nebraska, and Texas. All U.S. states face substantial avoidable costs from injury deaths. Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from the CDC's National Center for Injury Prevention and Control.§.

Economic Cost of Injury - United States, 2019.

Unintentional and violence-related injuries, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the top 10 causes of death for all age groups in the United States and caused nearly 27 million nonfatal emergency department (ED) visits in 2019.*,† CDC estimated the economic cost of injuries that occurred in 2019 by assigning costs for medical care, work loss, value of statistical life, and quality of life losses to injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).§ In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses. More than one half of this cost ($2.4 trillion) was among working-aged adults (aged 25-64 years). Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from CDC's National Center for Injury Prevention and Control.¶.

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level.

BACKGROUND: Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY DESIGN: Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years. RESULTS: Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD -16.5 percentage points; 95% CI, -17.1 to -15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD -0.4 percentage points; 95% CI, -0.8 to -0.1 percentage points). CONCLUSIONS: The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.

The societal cost of unintentional childhood injuries in Aotearoa.

AIMS: To estimate the burden and inequity of unintentional childhood injury for children in Aotearoa. METHODS: We used administrative data from the Accident Compensation Corporation (ACC) and the Ministry of Health to estimate the direct, indirect and intangible costs of unintentional injuries in children aged under 15 and the inequity of the impact of childhood injury on discretionary household income. We used an incidence approach and attributed all costs arising from injuries to the year in which those injuries were sustained. RESULTS: 257,000 children experienced unintentional injury in 2014, resulting in direct and indirect costs of almost $400 million. The burden of lost health and premature death was the equivalent of almost 200 full lives at perfect health. Pacific children had the highest incidence rates. Maori had the lowest rates of ACC claims but the highest rate of emergency department attendance. Children living with the highest levels of socioeconomic deprivation had the highest rate of hospital admission following injury. The proportional loss in discretionary income arising from an injury was higher for Maori and Pacific compared to non-Maori, non-Pacific households. CONCLUSION: The burden of unintentional childhood injury is greater than previously reported and has a substantial and iniquitous societal impact. There should be a focus on addressing inequities in incidence and access to care in order to reduce inequities in health and financial impact.

Comparación entre el coste y el cierre de heridas en una unidad de gestión clínica que incluye una enfermera de práctica avanzada en heridas crónicas complejas / Comparison between the cost and the wound closure in a Clinical Management Unit that includes an Advanced Practice Nurse on Complex Chronic Wounds

Introducción: Las heridas de difícil cicatrización o complejas que aquejan a un alto porcentaje de la población, además de afectar a la calidad de vida de quien las padece, repercute en un alto coste económico, en tiempo de enfermería y en estancias hospitalarias. Objetivo: Conocer el coste económico, las heridas complicadas, el coste medio para el cierre y la media de días para el mismo que ha tenido cada profesional de enfermería comparado con la enfermera de práctica avanzada (EPA) en heridas crónicas complejas (HCC) de la Unidad. Metodología: Estudio descriptivo longitudinal del total de los informes de valoración de heridas generados desde la aplicación de heridas en DIRAYA (sistema de información asistencial corporativo para todo el Servicio Andaluz de Salud, historia de salud única de todos los episodios asistenciales del ciudadano) y que necesitaron materiales de cura en ambiente húmedo suministrados por la Unidad de Gestión Clínica (UGC). El estudio se desarrolló en la UGC de Algarrobo, perteneciente al Área de Gestión Sanitaria Este de Málaga-Axarquía, desde junio 2019 hasta junio 2020. Se trata de una muestra conceptual, ya que se ha incluido a toda la población de enfermeros y enfermeras de la UGC y las correspondientes hojas emitidas por ellos. Resultados: Durante el periodo de estudio se registraron un total de 416 heridas en la Unidad, de las cuales se cerraron 338, el 81,2%. La EPA trató el 22,6% del total de las heridas (94 heridas) y resolvió el 90,4% de ellas, siendo el coste medio para el cierre de las heridas de 21,3 €, en un plazo medio de 30,7 días, mientras que el resto de profesionales tuvo que tratar de media 32,2 heridas y se resolvieron de media el 76,7%, siendo el coste medio para el cierre de una herida de 36,2 € en un plazo medio de 172,1 días (AU)

Introduction: Hard-to-heal or complex wounds that afflict a high percentage of the population, besides affecting the quality of life of the ones who suffer from them, impacts on a high economic cost, on nursing time and on hospital stays. Aims: Knowing the economic cost, complex wounds, average cost for closing and the average number of days for it that every nurse had compared to the Advanced Practice Nurse (APN) on complex chronic wounds from the unit. Methodology: Longitudinal descriptive study of the total injury assessment reports generated from the wounds application on DIRAYA (corporate healthcare information system for the entire Andalusian health service, unique Health Story of all citizen welfare episodes) and that needed healing material in a humid environment supplied by CMU. The study was developed in the Clinical Management Unit (CMU) of Algarrobo, belonging to the East Health Management Area of Málaga - Axarquía, since June 2019 until June 2020. This is a conceptual sample as the entire CMU nurse population and the corresponding pages issued by them have been included. Results: During the study period, a total of 416 wounds were registered in the Unit, of which 338 were closed, 81.2%. The APN treated 22.6% of the total wounds (94 wounds) and resolved the 90.4% of them, being the average cost for the wounds closure of 21.3 €, within an average of 30.7 days. While the rest of the professionals had to treat an average of 32.2 wounds and the average resolved was 76.7%, being the average cost for the wound closure of 36.2 € within an average of 172,1 days. Conclusions: The introduction of the APN on complex chronic wounds in the CMU had led the unit to a better result in terms of spending on materials and shortening the days for the wounds resolution, which influences a better quality of life for those who suffer from them (AU)

Coste-efectividad de la terapia avanzada con productos de cura en ambiente húmedo comparada con terapia tradicional en el tratamiento de úlceras por presión de categorías I y II / Cost-effectiveness of advanced therapy with moist environment dressings compared to traditional therapy in the treatment of Stage I and II pressure ulcers

Objetivo: Demostrar el coste-efectividad de la cura en ambiente húmedo (CAH) sobre la cura tradicional (CT) en pacientes hospitalizados con úlceras por presión (UPP) de categorías I y II. Metodología: Estudio longitudinal comparativo, aleatorizado, abierto, dividido en dos grupos, tratados y seguidos durante 4 semanas. El tamaño de la muestra se calculó con base en el metaanálisis de Heyer. Creamos un árbol de decisión para comparar el coste-efectividad de cada cura. Los datos se recopilaron directamente de los formularios de informes de casos de pacientes y los costes se extrajeron de los registros hospitalarios. Realizamos análisis de sensibilidad y costeefectividad incrementales. Resultados: El análisis mostró un dominio de la CAH sobre la CT (223,00€/0,84 vs. 298,00€/0,51), ya que fue más rentable al final del estudio. La hospitalización fue más corta en la CAH y la curación se logró en menos días que con la CT, lo que tiene un impacto en los costes relacionados con los tiempos de atención de enfermería, gasto de recursos materiales y días de hospitalización de los pacientes. Conclusiones: La CAH es más coste-efectiva que la CT cuando se aplica a pacientes hospitalizados con UPP de categorías I y II (AU)

Objective: To demonstrate the cost-effectiveness of the moist environment dressings treatment over the Traditional Cure (TC), in hospitalized patients, with Pressure Ulcers (UPP) categories I and II. Methods: This is a comparative, randomized, open-label, longitudinal study, comprising 60 patients, divided into two groups, treated and followed for four weeks. The sample size was calculated based upon the meta-analysis by Heyer. We built a decision tree to compare the cost-effectiveness of each therapy. Data were collected directly from patients' case report forms and costs extracted from hospital records. Additionally, we performed sensitivity and incremental cost-effectiveness analyses. Results: The analysis showed a dominance of advanced therapy over traditional therapy (€ 223.00/0.84 vs. € 298.00/0.51), as it was more cost-effective at the end of the study. Hospitalization was shorter in the advanced therapy and healing was achieved in fewer days than the traditional therapy. Conclusions: Advanced therapy with healing products in a humid environment is more cost-effective than traditional therapy when applied to hospitalized patients with category I and II pressure ulcers (AU)

Targeting zero preventable trauma readmissions.

BACKGROUND: Nearly 1-in-10 trauma patients in the United States are readmitted within 30 days of discharge, with a median hospital cost of more than $8,000 per readmission. There are national efforts to reduce readmissions in trauma care, but we do not yet understand which are potentially preventable. Our study aims to quantify the potentially preventable readmissions (PPRs) in trauma care to serve as the anchor point for ongoing efforts to curb hospital readmissions and ultimately, bring preventable readmissions to zero. METHODS: We identified inpatient hospitalizations after trauma and readmissions within 90 days in the 2017 National Readmissions Database (NRD). Potentially preventable readmissions were defined as the Agency for Healthcare Research and Quality-defined Ambulatory Care Sensitive Conditions, in addition to superficial surgical site infection, acute kidney injury/acute renal failure, and aspiration pneumonitis. Mean costs for these admissions were calculated using the NRD. A multivariable logistic regression model was used to characterize the relationship between patient characteristics and PPR. RESULTS: A total of 1,320,083 patients were admitted for trauma care in the 2017 NRD, and 137,854 (10.4%) were readmitted within 90 days of discharge. Of these readmissions, 22.7% were potentially preventable. The mean cost was $10,001/PPR, resulting in $313,802,278 in cost to the US health care system. Of readmitted trauma patients younger than 65 years, Medicaid or Medicare patients had 2.7-fold increased odds of PPRs compared with privately insured patients. Patients of any age with congestive heart failure had 2.9 times increased odds of PPR, those with chronic obstructive pulmonary disease or complicated diabetes mellitus had 1.8 times increased odds, and those with chronic kidney disease had 1.7 times increased odds. Furthermore, as the days from discharge increased, the proportion of readmissions due to PPRs increased. CONCLUSION: One-in-five trauma readmissions are potentially preventable, which account for more than $300 million annually in health care costs. Improved access to postdischarge ambulatory care may be key to minimizing PPRs, especially for those with certain comorbidities. LEVEL OF EVIDENCE: Economic and value-based evaluations, level II.

New concept: "TARN friendly trauma reporting" (what radiologists say really does matter).

AIM: To establish if detailed review of trauma reports with reference to coding manual improved accuracy of ISS and to establish if demonstrated changes in coding affected performance and tariff payment. MATERIALS AND METHODS: A study was undertaken which gathered data from 6 months across the five trusts with information on imaging undertaken, mechanism of injury (MOI), Injury Severity Score (ISS), and injury descriptors was included. Patients with ISS near to a best practice tariff boundary of 9 and 16 (5-8 and 11-15) then had their imaging reviewed by the Radiology Department with direct reference to the ISS coding manual. Injuries were then re-coded and ISS recalculated. RESULTS: Over the 6-month period, 1,693 patients were admitted to the database from the five hospitals. One hundred and sixty-nine (9.9%) patients met the inclusion criteria for review. Thirty-five (20.7%) had a change in abbreviated (region specific) injury code, with 30 a change in the resultant ISS. Three had a decrease in ISS and 27 increased ISS with all 27 moving across an ISS best practice tariff and three moving across two payment tariff boundaries. With re-coding, there was a potential £15,000 of lost revenue from the major trauma centre (MTC) alone. CONCLUSION: Reporting with reference to ISS description improves the accuracy of ISS significantly. Radiologists improving the descriptions of specific injury patterns and adopting 'Trauma Audit and Research Network friendly' reporting strategies may improve data accuracy, performance, and payment of best practice tariffs to hospitals.

Long-term medical and productivity costs of severe trauma: Results from a prospective cohort study.

BACKGROUND: Through improvements in trauma care there has been a decline in injury mortality, as more people survive severe trauma. Patients who survive severe trauma are at risk of long-term disabilities which may place a high economic burden on society. The purpose of this study was to estimate the health care and productivity costs of severe trauma patients up to 24 months after sustaining the injury. Furthermore, we investigated the impact of injury severity level on health care utilization and costs and determined predictors for health care and productivity costs. METHODS: This prospective cohort study included adult trauma patients with severe injury (ISS≥16). Data on in-hospital health care use, 24-month post-hospital health care use and productivity loss were obtained from hospital registry data and collected with the iMTA Medical Consumption and Productivity Cost Questionnaire. The questionnaires were completed 1 week and 1, 3, 6, 12 and 24 months after injury. Log-linked gamma generalized linear models were used to investigate the drivers of health care and productivity costs. RESULTS: In total, 174 severe injury patients were included in this study. The median age of participants was 55 years and the majority were male (66.1%). The mean hospital stay was 14.2 (SD = 13.5) days. Patients with paid employment returned to work 21 weeks after injury. In total, the mean costs per patient were €24,760 with in-hospital costs of €11,930, post-hospital costs of €7,770 and productivity costs of €8,800. Having an ISS ≥25 and lower health status were predictors of high health care costs and male sex was associated with higher productivity costs. CONCLUSIONS: Both health care and productivity costs increased with injury severity, although large differences were observed between patients. It is important for decision-makers to consider not only in-hospital health care utilization but also the long-term consequences and associated costs related to rehabilitation and productivity loss.

Futile trauma transfers: An infrequent but costly component of regionalized trauma care.

BACKGROUND: Appropriate interfacility transfers are a key component of highly functioning trauma systems but transfer of unsalvageable patients can overburden the resources of higher-level centers. We sought to identify the occurrence and associated reasons for futile transfers within our trauma system. METHODS: Using prospectively collected data from our system database, a retrospective cohort study was conducted to identify patients who underwent interfacility transfer to our American College of Surgeons level I center. Adult patients from June 2017 to June 2019 who died, had comfort measures implemented, were discharged, or went to hospice care within 48 hours of admission without significant operation, procedure, or radiologic intervention were examined. Futility was defined as resulting in death or hospice discharge within 48 hours of transfer without major operative, endoscopic, or radiologic intervention. RESULTS: A total of 1,241 patients transferred to our facility during the study period. Four hundred seven patients had a length of stay less than or equal to 48 hours. Eighteen (1.5%) met the criteria for futility. The most common reason for transfer in the futile population was traumatic brain injury (56%) and need for neurosurgical capabilities (62%). Futile patients had a median age and Injury Severity Score of 75 and 21. The main transportation method was ground 9 (50%) with 8 (44.4%) being transported by helicopter and 1 (5.6%) being transported by both. Combining transport costs with hospital charges, each futile transfer was estimated to cost US $56,396 (interquartile range, 41,889-106,393) with a total cost exceeding US $1.7 million. With an estimated 33,000 interfacility transfers annually for trauma in the United States, the cost of futile transfers to the American trauma system would exceed 27 million dollars each year. CONCLUSION: Futile transfers represent a small but costly portion transfer volume. Identification of patients whose conditions preclude the benefit of transfer due to futility and development of appropriate support for referral will significantly improve appropriate allocation of health care resources. LEVEL OF EVIDENCE: Economic; Care management, level IV.

Insult to injury: National analysis of return to work and financial outcomes of trauma patients.

BACKGROUND: While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors. METHODS: We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization. We used propensity score matching to identify noninjured respondents. Our primary outcome measure was postinjury return to work among trauma patients. Our secondary outcomes included measures of food insecurity, medical debt, accessibility and affordability of health care, and disability. RESULTS: A nationally weighted sample of 319,580 working-age trauma patients were identified. Of these patients, 51.7% were employed at the time of injury, and 58.9% of them had returned to work at the time of interview, at a median of 47 days postdischarge. Higher rates of returning to work were associated with shorter length of hospital stay, higher education level, and private health insurance. Injury was associated with food insecurity at an adjusted odds ratio (aOR) of 1.8 (95% confidence interval, 1.40-2.37), with difficulty affording health care at aOR of 1.6 (1.00-2.47), with medical debt at aOR of 2.6 (2.11-3.20), and with foregoing care due to cost at aOR of 2.0 (1.52-2.63). Working-age trauma patients had disability at an aOR of 17.6 (12.93-24.05). CONCLUSION: The postdischarge burden of injury among working-age US trauma survivors is profound-patients report significant limitations in employment, financial security, disability, and functional independence. A better understanding of the long-term impact of injury is necessary to design the interventions needed to optimize postinjury recovery so that trauma survivors can lead productive and fulfilling lives after injury. LEVEL OF EVIDENCE: Economic & Value-Based Evaluations, level II; Prognostic, level II.