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42 results on '"Gabbe, Belinda J."'

5. Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study

Author

Porgo, Teegwendé V, Moore, Lynne, Truchon, Catherine, Berthelot, Simon, Stelfox, Henry T, Cameron, Peter A, Gabbe, Belinda J, Hoch, Jeffrey S, Evans, David C, Lauzier, François, Bernard, Francis, Turgeon, Alexis F, and Clément, Julien

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Research, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Good Health and Well Being, Adult, Aged, Aged, 80 and over, Canada, Critical Care, Evidence-Based Practice, Female, Humans, Injury Severity Score, Length of Stay, Male, Middle Aged, Registries, Retrospective Studies, Trauma Centers, Wounds and Injuries, Trauma, Resource use intensity, Activity-based costing, Determinants, Inter-provider variations, Nursing, Public Health and Health Services, Orthopedics, Biomedical and clinical sciences, Clinical sciences, Dentistry, Health sciences
Abstract

BackgroundVariations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity.ObjectivesTo estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.MethodsWe conducted a retrospective cohort study including ≥16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f2. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.ResultsWe included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f2 = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% [20-40]).ConclusionsResource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting.

Published
2019

10. Characteristics, management and outcomes of patients with severe traumatic brain injury in Victoria, Australia compared to United Kingdom and Europe: A comparison between two harmonised prospective cohort studies

Author

Wiegers, Eveline J.A., Trapani, Tony, Gabbe, Belinda J., Gantner, Dashiell, Lecky, Fiona, Maas, Andrew I.R., Menon, David K., Murray, Lynnette, Rosenfeld, Jeffrey V., Vallance, Shirley, Lingsma, Hester F., Steyerberg, Ewout W., and Cooper, D. James

Published
2021
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35. An evaluation of the association between fault attribution and healthcare costs and trajectories in the first three years after transport injury

Author

Dipnall Joanna F, Giummarra Melita J, Ameratunga Shanthi, Gabbe Belinda J, Ponsford Jennie, and Collie Alex

Subjects
Biopsychosocial model, medicine.medical_specialty, business.industry, Major trauma, Health Care Costs, medicine.disease, Mental health, Treatment and control groups, Cohort Studies, Mental Health, Emergency medicine, Health care, Compensation and Redress, medicine, General Earth and Planetary Sciences, Humans, Attribution, business, Psychosocial, General Environmental Science, Cohort study, Pain Measurement
Abstract

Background People with complex medical and psychosocial issues have high healthcare needs. This registry-based cohort study sought to quantify the association between external fault attribution, recorded during compensation claim lodgement, and the cost and patterns of healthcare utilisation. Methods 6,144 survivors of transport-related major trauma between 1 July 2010 and 30 June 2016 were extracted from the Victorian State Trauma Registry (VSTR) and linked to treatment payments from the Transport Accident Commission (TAC). Associations between fault and healthcare costs were examined with Generalised Linear Regression. Healthcare trajectories were identified using Group-Based Multi-Trajectory Modelling and included medical treatments from a physician, or pain, mental health and physical therapy treatments for the first three years post-injury. Trajectories were validated against the EQ-5D-3L health status summary score using mixed linear regression. Results While injury severity had the strongest association with healthcare use, people who attributed fault to another had 9% higher healthcare costs. Six multi-trajectory groups were identified: 36% had low treatments over time; 25% had a rapid decline from high medical and physical therapy by 12-months; 12% had moderate to high medical and physical therapy that declined by 2-3 years; 11% had a gradual decline in medical treatment, an early increase in physical therapy but low pain and mental health treatment; 8% had high or increasing medical and physical therapy, moderate mental health therapy and low pain treatment; and 7% had moderate-high treatment across all domains. All groups had poorer health status compared with the group with low treatment levels, and people who attributed fault to another had higher risk of following trajectories with higher levels of treatment versus the low treatment group (beta=0.34, SE=0.12, p=0.01). Conclusion These findings highlight the need to provide pro-active multidisciplinary care coordination for people with complex needs after injury to better optimise recovery.

Published
2021

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