In hospital mortality after traumatic head injury: effect of patient insurance status
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and a major education program. Data was collected from 2845 tools over eight months and involved three phases: a baseline phase pre- intervention; 6 weeks post-intervention; and 6 months post- intervention. RESULTS: During phase I, the baseline period, 56% of eligible patients received beta blockers, but targeted measures (pre-induction heart rate 70 or systolic BP 110) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta blocker administration (79%) as well as efficacy (50%). However, during phase III (two months to six months post-implementation), the rate of beta blocker administration fell to 61% overall, an insignificant difference from overall baseline, and actually lower than the academic center’s baseline (77%), while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study. CONCLUSIONS: Our data suggest that implementation of a qual- ity program for beta blockade is significantly impacted by the pres- ence or absence of ongoing physician and staff education beyond the study period. Additionally, initial positive results, without periodic review of follow-up data, must be viewed with caution in these types of interventions. In hospital mortality after traumatic head injury: effect of patient insurance status Thomas Mitchell MD, Stephen DiRusso MD, PhD, Thomas Sullivan BS, Nanakram Agarwal MD, MPH, Deborah Benzil MD New York Medical College, Westchester Medical Center, Valhalla, NY INTRODUCTION: This study was undertaken to characterize the effect of insurance status on inhospital mortality in patients with Traumatic Closed Head Injury (TCHI). METHODS: Patient Population: New York Statewide Planning and Research Cooperative System (SPARCS) hospital discharge dataset from 1991-2001. Patients with TCHI were identified using ICD-9 head injury diagnosis codes. Statistical Analysis: A logistic regression model was used to predict mortality in patients with TCHI. Signif- icant variables in that model included age, Relative Head Injury Severity Scale (RHISS), ICD9 injury severity score (ICISS), age, volume of treated patients, and mechanism of injury. The SPARCS dataset includes a primary insurance payor variable which groups patient pay status into 18 categories. This was included as a categor- ical variable to the LR model in a stepwise fashion, and significant payor status components were identified. Odds ratios were com- puted for significant insurance status variables, referenced to self pay status. RESULTS: 178,642 patients were identified as having TCHI. The Area Under the Receiver Operating Characteristic Curve for mortal- ity prediction for both models was 0.93. Payor status as a whole was an independent predictor of mortality (p0.001). All significant insurance categories had improved odds ratios for survival over self pay patients. Odds ratios for several significant payors: Workman’s Comp: 3.46, Champus/VA: 2.50, No Fault: 2.39, Commercial 2.35, Blue Cross: 2.26, HMO: 2.10, Medicaid: 1.66, Medicare: 1.31. CONCLUSIONS: In NY State, self pay status portends a higher hospital mortality in patients with TCHI. S74 Quality, Outcomes, and Cost II J Am Coll Surg
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Transcript of In hospital mortality after traumatic head injury: effect of patient insurance status
and a major education program. Data was collected from 2845 toolsover eight months and involved three phases: a baseline phase pre-intervention; 6 weeks post-intervention; and 6 months post-intervention.
RESULTS: During phase I, the baseline period, 56% of eligiblepatients received beta blockers, but targeted measures (pre-inductionheart rate �70 or systolic BP �110) were achieved in only 11% ofpatients. Phase II saw a significant overall increase in beta blockeradministration (79%) as well as efficacy (50%). However, duringphase III (two months to six months post-implementation), the rateof beta blocker administration fell to 61% overall, an insignificantdifference from overall baseline, and actually lower than the academiccenter’s baseline (77%), while overall efficacy remained stable at52%. Significant differences between the academic and communityhospitals were observed throughout the study.
CONCLUSIONS: Our data suggest that implementation of a qual-ity program for beta blockade is significantly impacted by the pres-ence or absence of ongoing physician and staff education beyond thestudy period. Additionally, initial positive results, without periodicreview of follow-up data, must be viewed with caution in these typesof interventions.
In hospital mortality after traumatic head injury:effect of patient insurance statusThomas Mitchell MD, Stephen DiRusso MD, PhD,Thomas Sullivan BS, Nanakram Agarwal MD, MPH,Deborah Benzil MDNew York Medical College, Westchester Medical Center, Valhalla, NY
INTRODUCTION: This study was undertaken to characterize theeffect of insurance status on inhospital mortality in patients withTraumatic Closed Head Injury (TCHI).
METHODS: Patient Population: New York Statewide Planning andResearch Cooperative System (SPARCS) hospital discharge datasetfrom 1991-2001. Patients with TCHI were identified using ICD-9head injury diagnosis codes. Statistical Analysis: A logistic regressionmodel was used to predict mortality in patients with TCHI. Signif-icant variables in that model included age, Relative Head InjurySeverity Scale (RHISS), ICD9 injury severity score (ICISS), age,volume of treated patients, and mechanism of injury. The SPARCSdataset includes a primary insurance payor variable which groupspatient pay status into 18 categories. This was included as a categor-ical variable to the LR model in a stepwise fashion, and significantpayor status components were identified. Odds ratios were com-puted for significant insurance status variables, referenced to self paystatus.
RESULTS: 178,642 patients were identified as having TCHI. TheArea Under the Receiver Operating Characteristic Curve for mortal-ity prediction for both models was 0.93. Payor status as a whole wasan independent predictor of mortality (p�0.001). All significantinsurance categories had improved odds ratios for survival over selfpay patients. Odds ratios for several significant payors: Workman’sComp: 3.46, Champus/VA: 2.50, No Fault: 2.39, Commercial 2.35,Blue Cross: 2.26, HMO: 2.10, Medicaid: 1.66, Medicare: 1.31.
CONCLUSIONS: In NY State, self pay status portends a higherhospital mortality in patients with TCHI.
S74 Quality, Outcomes, and Cost II J Am Coll Surg
