Each year, nearly one million elders are hospitalized for treatment of an acute traumatic injury, and these figures are expected to increase as the proportion of the population that is older grows and their risk of falls, motor vehicle crashes and assaults increases due to improved overall health status and mobility. The outcome from trauma in the elderly is often poor as it serves as the incipient event in a cascade leading to immobility, incapacity and death. While a systems approach to the delivery of trauma care (with triage of the more acutely injured to designated tertiary care facilities or trauma centers) is widely advocated for improving these outcomes, there is substantial evidence to suggest that one half to two thirds of older adults with major trauma are not currently being treated at trauma centers, a far higher proportion than in younger patients. Available data, however, do not allow us to determine if outcomes are indeed better in trauma centers versus non-trauma centers. Even fewer data are available for comparing the costs of care received in trauma centers and non-trauma center hospitals.
The aims of the proposed study are three-fold: (1) to estimate the costs associated with the acute care and post-acute care of the elderly trauma patient and to compare these costs for patients treated at trauma centers and non-trauma centers; (2) to examine the contribution of pre-existing medical conditions on costs and outcomes following trauma in the elderly and to examine trauma center/non-trauma center differences among the elderly with pre-existing conditions; and (3) to describe the relationship between costs and outcomes of care received in trauma centers and non-trauma centers and examine the implications of these relationships for policy and program initiatives. The study takes advantage of an existing effort that is collecting one-year outcomes on over 3,000 elderly trauma patients treated at trauma centers and non-trauma centers. The current request is for funding an analysis of Medicare claims data. This analysis would substantially improve our ability to estimate costs of both acute and post-acute care related to the injury as well as provide better information on pre-injury morbidity which is known to substantially affect both outcomes and cost.
| Cooper, Zara; Rivara, Frederick P; Wang, Jin et al. (2009) Withdrawal of life-sustaining therapy in injured patients: variations between trauma centers and nontrauma centers. J Trauma 66:1327-35 |
| Ang, Darwin N; Rivara, Frederick P; Nathens, Avery et al. (2009) Complication rates among trauma centers. J Am Coll Surg 209:595-602 |
