TRAUMA SYSTEMS AND THE COSTS OF TRAUMA CARE

Objective. This study examines the cost of providing trauma services i n trauma centers organized by publicly administered trauma systems, co mpared to hospitals not part of a formal trauma system. Data Sources a nd Study Setting. Secondary administrative discharge abstracts for a n ational sample of severely injured trauma patients in 44 trauma center s and 60 matched control hospitals for the year 1987 were used. Study Design. Retrospective univariate and multivariate analyses were conduc ted to examine the impact of formal trauma systems and trauma center d esignation on the costs of treating trauma patients. Key dependent var iables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system an d level of trauma designation. Control variables included patient, hos pital, and community characteristics. Data Collection/Extraction Metho ds. Data were selected for hospitals based on (1) a large national hos pital discharge database, the Hospital Cost and Utilization Project, 1 980-1987 (HCUP-2) and (2) a special survey of trauma systems and traum a designation undertaken by the Hospital Research and Educational Trus t of the American Hospital Association. Principal Findings. The result s show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average leng ths of stay than other hospitals. These findings persist after control ling for patient injury and health status, and for demographic charact eristics and hospital and community characteristics. Conclusions. Prio r research shows that severely injured trauma patients have greater ch ances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trau ma systems since the high costs of Level I centers support limiting th e number of centers designated at this level and/or reconsidering the requirements placed on these centers.