Correlation of hospital charges and injury patterns using ... · injury patterns using statewide hospital discharge data CIREN Annual ... neck 5 25543.60 5516.08 7103.74 13569.92

Correlation of hospital charges and injury patterns using statewide

hospital discharge data

CIREN Annual Meeting

September 3, 2014

Overview

• To estimate the costs of injuries to different body regions

• CIREN’s inclusion criteria identifies a select group of injury patterns

• Interest in looking at cost (charges) of individual injuries for all hospitalized motor vehicle crash victims

Objectives • To provide average hospital costs (charges) by

most common single injury and most common pairs of injuries

• To provide the average cost (charges) at varying AIS severity levels – i.e. Chest AIS 2 vs 3 vs 4 vs 5

• To identify cost contribution per injury/injury level

• To look at incremental costs by injury severity

Background

• ‘The Economic and Societal Impact of Motor Vehicle Crashes, 2010’

• In 2010…

– 32,999 fatalities

– 3.9 million injuries

– 24 million vehicles damaged

Background

• Economic costs of crashes totaled $277B • Costs include

– Lost productivity ($93B) – Medical costs ($35B) – Legal and court costs – Emergency service costs – Insurance administration costs – Congestion costs ($28B) – Property damage – Workplace losses

Maryland Health Services Cost Review Commission

• Rate regulation established in 1971

• Sets rate for payers, including Medicare and Medicaid, since 1977

• Only state in nation to retain such a system

• 52 non-government entities reporting

• Ambulatory and inpatient care

Maryland HSCRC

• There are 170,108 injured (ICD9 800-959.99) discharge records in HSCRC 2009-2011 files, 11,203 with driver/passenger motor vehicle traffic E-codes; 4,006 with one and 2,857 with two MAIS body region injury (s).

2009 – 2011 HSCRC Inpatient Files

Year Injured Records* Motor Vehicle Traffic

Driver or Passenger**

2009 58,478 4,141

2010 56,299 3,579

2011 55,331 3,483

Total 170,108 11,203***

Maryland HSCRC

*At least one ICD-9 code between 800 and 959.99

**E-code:

MVT/Driver

E8100, E8110, E8120, E8130, E8140, E8150, E8160, E8170, E8180, E8190, E9585, E9885

MVT/Passenger

E8101, E8111, E8121, E8131, E8141, E8151, E8161, E8171, E8181, E8191

2009-2011 Inpatient file - MVT Driver and Passengers with ONE AIS body injury (N=4,006)

• Head 22.7%

• Lower extremity 22.4%

• Spine 14.3%

• Upper extremity 12.2%

• Face 12.0%

• Thorax 11.9%

• Abdomen 4.4%

Injury severity score

– 1 34.1%

– 4 38.3%

– 9 13.3%

– 16 7.7%

– 25 0.6%

2009-2011 Inpatient file - MVT Driver and Passengers with ONE AIS body injury (N=4,006)

*does not add to 100% due to AIS/ISS differences

2009-2011 Inpatient file - Hospital Charges of MVT Driver and Passengers with ONE AIS body injury (N=4,006)

Body

region n mean percent_25 median percent_75 total_chrg

1)head 909 11057.60 3828.38 4675.73 9046.70 10,051,360.44

2)face 481 6219.31 3805.04 4397.73 5810.09 2,991,486.46

3)neck 5 25543.60 5516.08 7103.74 13569.92 127,717.99

4)thorax 475 9117.77 3577.30 4674.41 7579.34 4,330,939.68

5)abd 177 8836.59 3675.96 4793.45 9518.40 1,564,076.03

6)spine 573 12646.55 3867.43 4693.68 8688.60 7,246,472.49

7)upext 489 11467.52 4009.51 5539.00 12666.24 5,607,615.19

8)lwext 897 16588.88 5547.46 12699.71 22026.22 14,880,224.14

2009-2011 Inpatient file - Length of Stay of MVT Driver and Passengers with ONE AIS body injury (N=4,006)

Body

region n min max mean percent_25 median percent_75 total_len_stay

1)head 909 0 67 3.68207 0 1 3 3347

2)face 481 0 22 1.16424 0 1 1 560

3)neck 5 0 22 5.40000 0 2 3 27

4)thorax 475 0 80 2.74526 1 1 3 1304

5)abd 177 0 19 2.41243 1 1 3 427

6)spine 573 0 33 2.30192 0 1 3 1319

7)upext 489 0 24 2.11861 0 1 3 1036

8)lwext 897 0 19 3.51951 1 3 5 3157

2009-2011 Inpatient file - MVT Driver and Passengers with TWO AIS body injury (N=2,857)

Obs head face neck thorax abd spine up_ext lw_ext COUNT PERCENT

1 1 1 0 0 0 0 0 0 409 14.3157

2 1 0 0 0 0 1 0 0 255 8.9254

3 0 0 0 0 0 0 1 1 247 8.6454

4 1 0 0 0 0 0 0 1 202 7.0704

5 0 0 0 1 0 0 0 1 199 6.9653

6 1 0 0 0 0 0 1 0 168 5.8803

7 1 0 0 1 0 0 0 0 158 5.5303

8 0 1 0 0 0 0 0 1 148 5.1803

9 0 0 0 1 0 0 1 0 137 4.7952

10 0 1 0 0 0 0 1 0 131 4.5852

11 0 0 0 1 0 1 0 0 118 4.1302

12 0 0 0 1 1 0 0 0 116 4.0602

13 0 0 0 0 0 1 0 1 101 3.5352

14 0 0 0 0 0 1 1 0 94 3.2902

15 0 1 0 0 0 1 0 0 77 2.6951

16 0 1 0 1 0 0 0 0 66 2.3101

17 0 0 0 0 1 0 0 1 63 2.2051

Focus on AIS 2+ injuries

• Hospitalized patients

• Majority of costs (charges)

ISS - 2009-2011 Inpatient file - MVT Driver and Passengers with One AIS 2+ injury (N=3,633)

one_ais2_body n min max mean percent_25 median percent_75

1)head 1572 4 26 6.18639 4 5 6

2)face 63 4 5 4.30159 4 4 5

3)neck 8 9 10 9.625 9 10 10

4)thorax 488 4 18 7.90369 5 9 10

5)abd 153 4 27 7.14379 4 5 6

6)spine 412 4 27 5.50971 4 4 5

7)upext 280 4 18 5.09643 4 5 5

8)lwext 657 4 16 5.85997 4 5 9

2009-2011 Inpatient file – Hospital Charges of MVT Driver and Passengers with One AIS 2+ injury (N=3,633)

one_ais2_body n mean percent_25 median percent_75 tot_hosp_charges 1)head 1572 6438.93 3696.41 4277.3 5495.36 10121997.01 2)face 63 9143.3 4196.27 5550.24 12225.31 576027.79 3)neck 8 20058.6 3666.9 7753.02 18184.71 160468.76 4)thorax 488 8999.84 3846.36 5080.48 7859.02 4391920.36 5)abd 153 10377.4 4501.01 6063.29 12149.95 1587741.8 6)spine 412 16183.84 4090.01 5461.08 11916.04 6667741.09 7)upext 280 10405.85 4245.34 6696.33 12549 2913638.53 8)lwext 657 16259.68 7069.75 14342.76 21765.85 10682611.25

2009-2011 Inpatient file - MVT Driver and Passengers with TWO MAIS (severity 2-6) body region injuries (N=2,102)

head face neck thorax abd spine upext lwext COUNT PERCENT 1 0 0 1 0 0 0 0 256 12.1789 1 0 0 0 0 0 0 1 246 11.7031 1 0 0 0 0 1 0 0 221 10.5138 0 0 0 1 0 0 0 1 192 9.1342 0 0 0 0 0 0 1 1 182 8.6584 1 0 0 0 0 0 1 0 152 7.2312 0 0 0 1 0 0 1 0 136 6.47 0 0 0 1 0 1 0 0 124 5.8991 0 0 0 1 1 0 0 0 120 5.7088 1 1 0 0 0 0 0 0 103 4.9001 0 0 0 0 0 1 0 1 92 4.3768 0 0 0 0 0 1 1 0 58 2.7593

Most Common Injuries (head) ais_code COUNT PERCENT

Length of Unconsciousness < 1 Hr. (2) 2191 31.304

Length of unconsciousness unkown (2) 976 13.945

Scalp laceration NFS (1) 762 10.887

Cerebrum hematoma/hemorrhage subdural NFS (4) 563 8.044

Closed head injury NFS (9) 515 7.358

Base (basilar) skull fracture NFS (3) 468 6.687

Cerebrum subarachnoid hemorrhage 336 4.801

Cerebrum laceration 293 4.186

Cerebrum hematoma/hemorrhage NFS - extra axial 220 3.143

Length of Unconsciousness < 1 Hr. 135 1.929

Length of Unconsciousness known to be > 24 hrs. 89 1.272

Vault skull fracture closed 82 1.172

Most Common Injuries (face)

ais_code COUNT PERCENT

Facial Skin laceration NFS 1863 35.765

Facial Skin contusion 856 16.433

Facial Skin abrasion 703 13.496

Nose fracture closed 432 8.293

Maxilla fracture closed 241 4.627

Facial bone(s) fracture NFS 239 4.588

Orbit fracture closed 197 3.782

Eye NFS 115 2.208

Most Common Injuries (neck)


Carotid (common, internal) artery NFS 94 70.149

Neck/Throat Skin laceration NFS 36 26.866

Most Common Injuries (thorax) ais_code COUNT PERCENT

Lung contusion NFS with or without hemo-/pneumothorax (3)

1212 20.775

Thoracic cavity injury NFS with hemo/pneumo (3) 876 15.015

Chest Skin contusion (OIS Grade I) (1) 791 13.558

Rib cage fracture 2-3 ribs any location (OIS Grade I, II or III) (2)

513 8.793

Sternum fracture (OIS Grade II or III) 424 7.268

Rib cage fracture 1 rib 351 6.016

Rib cage fracture 2-3 ribs any location with hemo-/pneumothorax

305 5.228

Rib cage fracture >3 ribs on one side and <=3 ribs on the other side, stable chest (3)

239 4.097

Most Common Injuries (abdomen)


Abdomen Skin contusion (1) 505 18.546

Abdominal injury NFS 214 7.859

Abdomen Skin abrasion 212 7.786

Spleen NFS (2) 148 5.435

Liver laceration NFS (2) 135 4.958

Spleen laceration major (OIS Grade IV) (4) 134 4.921

Mesentery NFS 108 3.966

Spleen laceration minor (OIS Grade I or II) 94 3.452

Jejunum-ileum NFS 80 2.938

Liver laceration moderate (OIS Grade III) 80 2.938

Kidney laceration NFS 73 2.681

Liver laceration major (OIS Grade IV) 73 2.681

Most Common Injuries (spine)


Cervical Spine Strain (1) 857 22.588

Cervical Spine fracture (2) 831 21.903

Lumbar Spine Fracture NFS 690 18.187

Thoracic Spine fracture NFS 446 11.755

Lumbar Spine Strain 340 8.962

Thoracic Spine Strain 209 5.509

Cervical Spine dislocation 112 2.952

Cervical Spine Cord contusion with transient neurological signs with fracture

45 1.186

Most Common Injuries (upper extremity)


Upper Extremity Skin laceration NFS 687 14.304

Upper Extremity Skin abrasion 588 12.242

Upper Extremity Skin contusion 487 10.139

Radius fracture closed 445 9.265

Clavicle fracture (OIS Grade I or II) 394 8.203

Ulna fracture closed 365 7.599

Humerus fracture closed 307 6.392

Carpus or metacarpus fracture 296 6.163

Scapula fracture (OIS Grade II) 203 4.227

Most Common Injuries (lower extremity)


Pelvis fracture closed 695 9.91

Lower Extremity Skin abrasion 519 7.401

Lower Extremity Skin laceration NFS 486 6.93

Lower Extremity Skin contusion 412 5.875

Femur fracture shaft 377 5.376

Tibia fracture NFS 363 5.176

Symphysis pubis separation 362 5.162

Knee contusion 289 4.121

Tibia fracture condyles 273 3.893

Metatarsal or Tarsal fracture 267 3.807

Fibula fracture bimalleolar or trimalleolar 229 3.265

Fibula fracture head, neck, shaft 228 3.251

Statistical Methods

• Analysis of Variance (ANOVA) applied to measure effect of increment in MAIS of each body region on hospital charges

• Outcome = Hospital Charges – Transformed due to skewness (non-normality) – Interpreted as % change in hospital charges when transformed

back to original units

• Independent variables = MAIS scores by body region – Initially analyzed to determine MAIS increment between

adjacent categories with largest change in hospital charges – Isolated body region or combination of 2 body regions – Isolated injuries also adjusted by age and sex

Frequency and Percent of Isolated Head MAIS Categories

2009-2011

Head MAIS Categories Frequency Percent

0 606 40.7

1 71 4.8

2 454 30.5

3 60 4.0

4 249 16.7

5 18 1.2

9 31 2.1

Effect of Increments in Isolated Head MAIS on

% Change in Hospital Charges

2009-2011

HEAD % Change p-value

MAIS 1 vs. MAIS 0 -2.5% 0.78

MAIS 2 vs. MAIS 1 -6.8% 0.44

MAIS 3 vs. MAIS 2 76.3% <0.001

MAIS 4 vs. MAIS 3 17.2% 0.08

MAIS 5 vs. MAIS 4 -5.8% 0.73

Effect of Increments in Isolated Head MAIS on


Adjusted by Age and Sex

2009-2011

HEAD % Change p-value

MAIS 1 vs. MAIS 0 -1.9% 0.82

MAIS 2 vs. MAIS 1 -4.7% 0.59

MAIS 3 vs. MAIS 2 71.1% <0.001

MAIS 4 vs. MAIS 3 17.0% 0.08

MAIS 5 vs. MAIS 4 -5.6% 0.74

Frequency and Percent of Isolated Face MAIS Categories

2009-2011

Face MAIS Categories Frequency Percent

0 606 57.2

1 401 37.8

2 52 4.9

Effect of Increments in Isolated Face MAIS on


2009-2011

FACE % Change p-value

MAIS 1 vs. MAIS 0 -3.0% 0.42

MAIS 2 vs. MAIS 1 45.1% <0.001

Effect of Increments in Isolated Face MAIS on



2009-2011

FACE % Change p-value

MAIS 1 vs. MAIS 0 -0.5% 0.88

MAIS 2 vs. MAIS 1 44.9% <0.001

Frequency and Percent of Isolated Neck MAIS Categories

2009-2011

Neck MAIS Categories Frequency Percent

0 606 99.2

1 2 0.3

3 3 0.5

Frequency and Percent of Isolated Thorax MAIS Categories

2009-2011

Thorax MAIS Categories Frequency Percent

0 606 56.4

1 144 13.4

2 123 11.4

3 186 17.3

4 16 1.5

Effect of Increments in Isolated Thorax MAIS on


2009-2011

THORAX % Change p-value

MAIS 1 vs. MAIS 0 3.0% 0.62

MAIS 2 vs. MAIS 1 -0.1% 0.99

MAIS 3 vs. MAIS 2 20.5% 0.01

MAIS 4 vs. MAIS 3 44.5% 0.01

Effect of Increments in Isolated Thorax MAIS on



2009-2011

THORAX % Change p-value

MAIS 1 vs. MAIS 0 -6.4% 0.30

MAIS 2 vs. MAIS 1 -6.9% 0.39

MAIS 3 vs. MAIS 2 28.5% <0.001

MAIS 4 vs. MAIS 3 36.0% 0.03

Frequency and Percent of Isolated Abdomen MAIS Categories

2009-2011

Abdomen MAIS Categories Frequency Percent

0 606 77.9

1 78 10.0

2 72 9.3

3 5 0.6

4 13 1.7

5 3 0.4

9 1 0.1

Effect of Increments in Isolated Abdomen MAIS on


2009-2011

Abdomen % Change p-value

MAIS 1 vs. MAIS 0 -17.0% 0.03

MAIS 2 vs. MAIS 1 63.2% <0.001

MAIS 3 vs. MAIS 2 10.2% 0.73

MAIS 4 vs. MAIS 3 3.6% 0.91

MAIS 5 vs. MAIS 4 63.9% 0.11

Effect of Increments in Isolated Abdomen MAIS on



2009-2011

Abdomen % Change p-value

MAIS 1 vs. MAIS 0 -13.8% 0.06

MAIS 2 vs. MAIS 1 59.5% <0.001

MAIS 3 vs. MAIS 2 9.0% 0.75

MAIS 4 vs. MAIS 3 11.4% 0.72

MAIS 5 vs. MAIS 4 43.2% 0.27

Frequency and Percent of Isolated Spine MAIS Categories

2009-2011

Spine MAIS Categories Frequency Percent

0 606 51.6

1 246 21.0

2 266 22.7

3 31 2.6

4 22 1.9

5 3 0.3

Effect of Increments in Isolated Spine MAIS on


2009-2011

SPINE % Change p-value

MAIS 1 vs. MAIS 0 -12.3% 0.02

MAIS 2 vs. MAIS 1 60.5% <0.001

MAIS 3 vs. MAIS 2 21.6% 0.11

MAIS 4 vs. MAIS 3 134.0% <0.001

MAIS 5 vs. MAIS 4 7.8% 0.86

Effect of Increments in Isolated Spine MAIS on



2009-2011

SPINE % Change p-value

MAIS 1 vs. MAIS 0 -10.2% 0.05

MAIS 2 vs. MAIS 1 55.0% <0.001

MAIS 3 vs. MAIS 2 22.2% 0.09

MAIS 4 vs. MAIS 3 129.4% <0.001

MAIS 5 vs. MAIS 4 15.6% 0.72

Frequency and Percent of Isolated Upper Extremity MAIS Categories

2009-2011

Upper Extremity MAIS Categories Frequency Percent

0 606 55.8

1 235 21.6

2 189 17.4

3 54 5.0

9 3 0.3

Effect of Increments in Isolated Upper Extremity MAIS on


2009-2011

UPPER EXTREMITY % Change p-value

MAIS 1 vs. MAIS 0 3.3% 0.52

MAIS 2 vs. MAIS 1 56.3% <0.001

MAIS 3 vs. MAIS 2 82.2% <0.001

Effect of Increments in Isolated Upper Extremity MAIS on



2009-2011

UPPER EXTREMITY % Change p-value

MAIS 1 vs. MAIS 0 3.6% 0.48

MAIS 2 vs. MAIS 1 55.9% <0.001

MAIS 3 vs. MAIS 2 84.1% <0.001

Frequency and Percent of Isolated Lower Extremity MAIS Categories

2009-2011

Lower Extremity MAIS Categories Frequency Percent

0 606 40.6

1 204 13.7

2 465 31.2

3 213 14.3

4 3 0.2

9 1 0.1

Effect of Increments in Isolated Lower Extremity MAIS on


2009-2011

LOWER EXTREMITY % Change p-value

MAIS 1 vs. MAIS 0 3.9% 0.48

MAIS 2 vs. MAIS 1 99.0% <0.001

MAIS 3 vs. MAIS 2 23.0% <0.001

MAIS 4 vs. MAIS 3 67.4% 0.09

Effect of Increments in Isolated Lower Extremity MAIS on



2009-2011

LOWER EXTREMITY % Change p-value

MAIS 1 vs. MAIS 0 4.4% 0.42

MAIS 2 vs. MAIS 1 97.8% <0.001

MAIS 3 vs. MAIS 2 22.9% <0.001

MAIS 4 vs. MAIS 3 59.4% 0.13

85%

43%

26%

53%

66%

77%

110%

0

20

40

60

80

100

120

Head 3+(n=327)

Face 2+(n=52)

Thorax 3+(n=202)

Abd 2+(n=93)

Spine 2+(n=322)

Up Ext 2+(n=243)

Lw Ext 2+(n=681)

% C

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Max MAIS of Isolated Body Regions

Effect of Maximum Difference in MAIS of Isolated Body Regions on % Change in Hospital Charges

101% 82% 89%

101%

148% 164%

0%

50%

100%

150%

200%

250%

300%

Head 3+ Face 2+

% C

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MAIS 2+ MAIS 3+ MAIS 4+ MAIS 5+

Increments in Head MAIS

n=3 n=100 n=75 n=28 n=3 n=0 n=0

Increments in Face MAIS

Effect of Combinations of Head and Face MAIS Injuries on % Change in Hospital Charges

MAIS = 0 or 1 for All Other Body Regions

n=75

109%

64%

119% 119% 116%

140%

164%

0%

50%

100%

150%

200%

250%

300%

Head 3+ Thorax 3+

% C

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n=71 n=198 n=71 n=47 n=14 n=3 n=0

Increments in Thorax MAIS

Effect of Combinations of Head and Thorax MAIS Injuries on % Change in Hospital Charges


n=89

133%

80%

287%

133%

269%

140%

115%

0%

50%

100%

150%

200%

250%

300%

Head 3+ Spine 2+

% C

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n=7 n=216 n=81 n=48 n=2 n=4 n=0

Increments in Spine MAIS

Effect of Combinations of Head and Spine MAIS Injuries on % Change in Hospital Charges


n=81

104%

54%

164%

104%

114%

140%

0%

50%

100%

150%

200%

250%

300%

Head 3+ Upper Extremity 2+

% C

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n=2 n=150 n=38 n=27 n=1 n=0 n=0

Increments in Upper Ext MAIS

Effect of Combinations of Head and Upper Extremity MAIS Injuries on % Change in Hospital Charges


n=38

137%

98%

147% 137%

133%

97%

0%

50%

100%

150%

200%

250%

300%

Head 3+ Lower Extremity 2+

% C

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Ho

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n=18 n=246 n=55 n=37 n=4 n=0 n=0

Increments in Lower Ext MAIS

Effect of Combinations of Head and Lower Extremity MAIS Injuries on % Change in Hospital Charges


n=55

104% 102% 116%

104% 120%

147% 162%

0%

50%

100%

150%

200%

250%

300%

Thorax 3+ Abdomen 2+

% C

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n=33 n=112 n=87 n=13 n=0 n=4 n=24

Increments in Abdomen MAIS

Effect of Combinations of Thorax and Abdomen MAIS Injuries on % Change in Hospital Charges


n=87

111% 95%

223%

111%

224%

166%

222%

0%

50%

100%

150%

200%

250%

300%

Thorax 3+ Spine 2+

% C

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Ho

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n=12 n=118 n=81 n=10 n=0 n=2 n=5


Effect of Combinations of Thorax and Spine MAIS Injuries on % Change in Hospital Charges


n=81

78% 74%

117%

78%

114%

0%

50%

100%

150%

200%

250%

300%

Thorax 3+ Upper Extremity 2+

% C

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Ho

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n=7 n=131 n=88 n=9 n=0 n=0 n=0


Effect of Combinations of Thorax and Upper Extremity MAIS Injuries on % Change in Hospital Charges


n=88

153% 149% 139%

153%

223%

0%

50%

100%

150%

200%

250%

300%

Thorax 3+ Lower Extremity 2+

% C

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n=67 n=183 n=137 n=17 n=0 n=0 n=0


Effect of Combinations of Thorax and Lower Extremity MAIS Injuries on % Change in Hospital Charges


n=137

126% 126% 133%

260%

262%

0%

50%

100%

150%

200%

250%

300%

Spine 2+ Lower Extremity 2+

% C

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Ho

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n=32 n=83 n=2 n=1 n=0 n=0 n=0


Effect of Combinations of Spine and Lower Extremity MAIS Injuries on % Change in Hospital Charges


n=83

154% 154% 175%

198%

0%

50%

100%

150%

200%

250%

300%

Upper Extremity 2+ Lower Extremity 2+

% C

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n=72 n=177 n=15 n=0 n=0 n=0 n=0


Effect of Combinations of Upper and Lower Extremity MAIS Injuries on % Change in Hospital Charges


n=177

Conclusions

• Majority of hospital admissions had moderate to severe injuries in one or two body regions

• Individual body region costs (charges) were highest for lower extremities

• Cost (charges) increase is greatest where injuries progress from medical management to surgical management which is reflected by AIS and varies by body region

Conclusions

• Cost (charge) differences were largely unchanged when accounting age and sex

• Costs (charges) largely doubled when going from one injured body region to two

• Lower extremities are included in three of the top five pairs of injured body regions

Any questions…….. Tim Kerns [email protected] Pat Dischinger [email protected] Joe Kufera [email protected] Shiu Ho [email protected] Cindy Burch [email protected]

mailto:[email protected]





Documents

Correlation of hospital charges and injury patterns using ... · injury patterns using statewide hospital discharge data CIREN Annual ... neck 5 25543.60 5516.08 7103.74 13569.92