The implications of alcohol intoxication and the Uniform Policy Provision Law on trauma centers; a national trauma data bank analysis of minimally injured patients

Terence OKeeffe, Shahid Shafi, Jason L. Sperry, Larry M. Gentilello

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. METHODS: The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age ≥16 years) who were discharged alive, had a length of stay ≤1 day and minor injuries (Injury Severity Score <9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 ± 225 vs. 8,572 ± 68). CONCLUSIONS: A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.

Original languageEnglish (US)
Pages (from-to)495-498
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

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Alcoholic Intoxication
Trauma Centers
Alcohols
Databases
Wounds and Injuries
Odds Ratio
Confidence Intervals
Hospital Charges
Routine Diagnostic Tests
Cost Allocation
Costs and Cost Analysis
Injury Severity Score
Hospital Costs
Therapeutic Uses
Insurance
Intubation
Intensive Care Units
Hospital Emergency Service
Length of Stay
Catheters

Keywords

  • Alcohol
  • Health policy
  • Injury
  • Insurance
  • Trauma centers
  • Uniform Policy Provision Law

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{8c3ef8b3e4ff4abd9f40fa769f45d271,
title = "The implications of alcohol intoxication and the Uniform Policy Provision Law on trauma centers; a national trauma data bank analysis of minimally injured patients",
abstract = "BACKGROUND: Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. METHODS: The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age ≥16 years) who were discharged alive, had a length of stay ≤1 day and minor injuries (Injury Severity Score <9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95{\%} confidence intervals (CI). RESULTS: Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95{\%} CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95{\%} CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95{\%} CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95{\%} CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95{\%} CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95{\%} CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 ± 225 vs. 8,572 ± 68). CONCLUSIONS: A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.",
keywords = "Alcohol, Health policy, Injury, Insurance, Trauma centers, Uniform Policy Provision Law",
author = "Terence OKeeffe and Shahid Shafi and Sperry, {Jason L.} and Gentilello, {Larry M.}",
year = "2009",
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TY - JOUR

T1 - The implications of alcohol intoxication and the Uniform Policy Provision Law on trauma centers; a national trauma data bank analysis of minimally injured patients

AU - OKeeffe, Terence

AU - Shafi, Shahid

AU - Sperry, Jason L.

AU - Gentilello, Larry M.

PY - 2009/2/1

Y1 - 2009/2/1

N2 - BACKGROUND: Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. METHODS: The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age ≥16 years) who were discharged alive, had a length of stay ≤1 day and minor injuries (Injury Severity Score <9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 ± 225 vs. 8,572 ± 68). CONCLUSIONS: A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.

AB - BACKGROUND: Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges. METHODS: The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age ≥16 years) who were discharged alive, had a length of stay ≤1 day and minor injuries (Injury Severity Score <9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 ± 225 vs. 8,572 ± 68). CONCLUSIONS: A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.

KW - Alcohol

KW - Health policy

KW - Injury

KW - Insurance

KW - Trauma centers

KW - Uniform Policy Provision Law

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