Faculty Collaboration Database

Superusers: Drivers of health care resource utilization in the national trauma population. Surgery 2018 Oct;164(4):848-855

Date

08/11/2018

Pubmed ID

30093276

DOI

10.1016/j.surg.2018.04.046

Scopus ID

2-s2.0-85051027858 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: Health care spending is driven by a very small percentage of Americans, many of whom are patients with prolonged durations of stay. The objective of this study was to characterize superusers in the trauma population.

METHODS: The National Trauma Data Bank for 2008-2012 was queried. Superusers were defined as those with a duration of stay in the top 0.06% of the population and were compared with the remainder of the population to determine differences in demographic characteristics, comorbidities, prehospital factors, and outcomes. Multivariate analysis was used to determine independent predictors of being classified as a superuser.

RESULTS: A total of 3,617,261 patients met inclusion criteria, with 34,728 qualifying as superusers. Mean duration of stay for superusers was 58.7 days compared with the average 4.6 days (P < .001). Superusers were more likely to be male, black, Medicaid insured, and have a higher Injury Severity Score and lower Glasgow Coma Scale score. The hospital course of superusers was likely to be complicated by pneumonia, acute respiratory distress syndrome, decubitus ulcer, and acute kidney injury.

CONCLUSION: Age, sex, race, and insurance were associated with prolonged use of inpatient care in the trauma patient population. Specific comorbidities and complications are associated with being a superuser. This subset of the trauma population confers a disproportionate burden on the health care system and can serve as a potential target for intervention.

Author List

Gil LA, Kothari AN, Brownlee SA, Ton-That H, Patel PP, Gonzalez RP, Luchette FA, Anstadt MJ

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Comorbidity
Databases, Factual
Female
Health Resources
Humans
Male
Middle Aged
Patient Acceptance of Health Care
Risk Factors
Trauma Severity Indices
United States
Wounds and Injuries
Young Adult