Lewis E. Jacobson

Implications of Thoracic Epidural Analgesia on Hospital Charges in Rib Fracture Patients

Objective Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not. Thus, we evaluated the financial implications of one mode of treatment for patients with rib fractures: thoracic epidural analgesia (TEA). Methods We retrospectively analyzed the registry of a level II trauma center. All patients who fractured one or more ribs (n = 1,344) were considered; 382 of those patients were not candidates for epidural placement and were eliminated from analyses. Epidural placement was determined by individual clinicians. We used multiple linear regressions to determine predictors of cost. Results After eliminating patients who were not eligible to receive TEA, the average patient bill was

Do Contradictions in TQIP Measures Affect Perceptions of Quality. An Analysis of TQIP Definitions On Quality Outcomes for Placement of ICP monitoring at a Single Level One Trauma Center.

59,123 (

The Interrelationship Between Depression and Hemoglobin: Men Are Affected More Than Women

10,631 per day of treatment). The administration of TEA predicted a 25% reduction in total billing (99% CI = -

Obesity in the Trauma Patient Delays Hospital Discharge and Increases Treatment Cost: 2455 Board #291 June 1 9

21,429.55- -

Alcohol and Cardiovascular Health: Acute Alterations Versus Chronic Adaptations

7,794.66) and a 24% reduction in per-day billing (99% CI = -

Overturning the Hypothesis that Cigarettes Can Enhance Hematocrit and Improve Aerobic Capacity: 368 Board #209 May 30 9

3,745.99- -

A Curious Relationship Between Obesity, Diabetes, and Dementia: 989 Board #250 May 30 2

1,276.14). Conclusions Patients who received TEA were more severely injured and required longer treatments; controlling for these variables, the use of TEA associated with reductions in the cost of receiving care. From an administrative and insurance perspective, more frequent reliance on TEA may be indicated.

Obesity Associated Hypertension in Admitted Patients: Treating Isolated Systolic Hypertension May Be Short Sighted

BACKGROUND TQIP quality measures as currently defined on occasion provide discordant conclusions. A recent TQIP report of an urban level one-trauma center suggested a low employment of ICP monitoring while also demonstrating aggressive implementation of ICP monitoring (ave. within 90 min of arrival). This apparent contradiction leads to the question; Does TQIP define correctly the patient cohort who would most benefit from ICP monitoring? METHODS A retrospective IRB approved review of all patients reported to TQIP with severe TBI was performed at an ACS verified level one trauma center. All patients admitted to the TS during the TQIP study period were reviewed. Demographic data as well as AIS, ISS, GCS, injury type and outcomes were reviewed. Data were reported as aggregate. RESULTS Trauma registry review determined 108 patients met the TQIP definition for severe TBI. Analysis of these patients revealed only 58%(63) met clinical criteria for severe TBI. In this group 45.4%(49) suffered non-survivable TBI. ICP monitoring was not initiated in this subgroup of patients. 42%(45) of the patients were determined to have mild to moderate TBI. In this cohort the initial GCS reported in the trauma registry overestimated the severity of the TBI in 19.4%(21) of the patients. ICP monitoring was initiated 29%(30) patients. The analysis would indicate 13%(14) would have benefited from ICP monitoring indicating an 15%(16) over utilization. The majority of these patients sustained meaningful neurologic recovery indicating a better-defined criterion may be necessary to determine when ICP monitoring is a quality indicator. CONCLUSION This study indicates the current TQIP definition used to justify ICP monitoring appears to overestimate the number of patients who would benefit from ICP monitoring. The corrected quality analysis indicates an overutilization rather than an underutilization of ICP monitoring. Further study of the effect of definitions on quality measures should be considered.