title: The association between cost and quality in trauma: is greater spending associated with higher-quality care?
abstract: OBJECTIVE
  To examine the association between trauma center quality and costs.
  
  
  BACKGROUND
  Current efforts to reduce health care costs and improve health care quality require a better understanding of the relationship between cost and quality.
  
  
  METHODS
  Using data from the Healthcare Cost and Utilization Projects Nationwide Inpatient Sample, we performed a retrospective observational study of 67,124 trauma patients admitted to 73 trauma centers. Generalized linear models were used to explore the association between hospital cost and in-hospital mortality, controlling for hospital and patient factors as follows: injury diagnoses, age, gender, mechanism of injury, comorbidities, teaching status, hospital ownership, geographic region, and hospital wages.
  
  
  RESULTS
  Patients treated in hospitals with low risk-adjusted mortality rates had significantly lower costs than those treated in average-quality hospitals. The relative cost of patients treated in high-quality hospitals was 0.78 (95% confidence interval: 0.64, 0.95) compared with average-quality hospitals. The cost of treating patients in average- and high-mortality trauma centers was similar.
  
  
  CONCLUSIONS
  In this study based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the care of injured patients is less expensive in hospitals with lower risk-adjusted mortality rates. Hospitals with low risk-adjusted mortality rates have adjusted mortality rates that are 34% lower while spending nearly 22% less compared with average-quality hospitals.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine, University of Rochester Medical Centre, Rochester, NY, USA. Laurent_Glance@urmc.rochester.edu
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.forename: Turner M
authors.initials: TM
authors.lastname: Osler
authors.forename: Wayne
authors.initials: W
authors.lastname: Meredith
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000328:Adult; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000191:economics* / Q000592:standards*; D014481:United States