A MODEL FOR REAL TIME ACTIVITY BASED COSTING IN ACUTE TRAUMA CARE

Purpose: Injury, which accounts for more loss of human potential than any other condition, is also estimated to cost 26.8 billion dollars a year in Canada, and 406 billion dollars a year in the United States. Streamlining the costs of trauma is an urgent priority for health systems. To date, there have been very few well-designed economic studies of trauma care, possibly because of the tremendous heterogeneity, unpredictability and variability of trauma patients and of systems of trauma care. Time-driven activity based costing (TDABC), which maps processes of care, while attaching costs to all of the details in these processes, has emerged as a promising strategy to measure the true costs of health care, and to identify opportunities along the process of care to improve efficiency and value. This study describes the creation of a mobile user interface that is used by clinicians at the point of acute trauma resuscitation to collect high resolution clinical data, link it to costs, and generate individualized TDABC process maps.  

Methods: A mobile, electronic, point of care data collection and analytics tool for acute trauma care was designed with standardized fields to collect a comprehensive array of trauma resuscitation data. The cost implications of all trauma resuscitation data fields (n=2000) were reviewed, and costing relevant fields were classified as relating to personnel, equipment, consumables, or space. Costs and times (where possible) were assigned to each of the data elements using national actuarial databases. Algorithms were designed to combine costs and times, where needed, to estimate per patient cost contributions of linear processes.   

Results: In simulation, trauma teams were able to capture clinical data in real time using an intuitive, graphical user interface. All data elements were instantaneously linked to costs and reported using interactive, real time process maps.

Conclusions: It is feasible to create real-time, cost-linked process maps (Figure), even for such highly variable processes as acute trauma care. Microcosting is limited by the availability of true costs, but this limitation can be offset through modeling of more common charge data, and, ultimately, through ongoing attention to and measurement of discrete costs in complex care processes. This is a first step in reducing the great financial burden of trauma care, and of injury in general.