The economic burden of prescription opioid abuse is believed to be substantial, however it is not known whether total and per-event hospital (ED and inpatient) costs associated with opioid abuse or misuse differ by insurance status. We also wanted identify predictors of charges. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the sampling design of the NEDS, we estimated national total and mean charges -- overall and by insurance status (Medicare, Medicaid, private insurance, or self-payment). Charges were adjusted using the 2010 Medical Consumer Price Hospital Services index. We used a log-linked gamma regression model to assess potential predictors of charges. The number of opioid abuse-related events was 515,896; 506,837; and 564,559 for 2006, 2007, and 2008, respectively. Approximately 55% visits in each year resulted in inpatient admissions. Total charges billed for opioid abuse-related events were US$9.8; 9.6; and 9.5 billion for 2006, 2007, and 2008, respectively. Medicaid patients had the highest charges in each years followed by Medicare patients. Approximately 93% of total charges were due to subsequent inpatient admission. Overall unadjusted mean charges were $20,651; $20,373; and $18,384 for 2006, 2007, and 2008, respectively. Compared to events paid for by private insurance, Medicaid-covered events had significantly higher mean charges, and self-paid events had significantly lower charges (p < 0.001 for each year). Inpatient admissions resulted in significantly higher mean charges compared to treat-and-release ED visits (p < 0.001 for each year). We found similar results after adjusting for clinical and demographic factors. Age, number of diagnoses, inpatient admission, presence of cardiac tissue disorders, respiratory infections or failure, gastrointestinal hemorrhage, and acute pancreatitis were significantly positively associated with total charges billed (p < 0.001 for all). This study helps in determining differences in hospital costs of opioid abusers by insurance status and in identifying potential predictors of such costs, resulting in better understanding the economic burden of opioid abuse on the healthcare system. / text

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In order to describe the trend, characteristics, and cost of occupational injuries that occurred in industrial settings across the United States between 1998 and 2009, a cross sectional analysis based on hospital discharge data was conducted. The National Inpatient Sample (NIS) data from the Healthcare and Cost Utilization Project (HCUP)(1) was used. Identification of relevant injuries from the sample was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises)(8). A total of 307,586 (weighted) patients with industrial related injuries were discharged from hospitals in the United States during the period 1998-2009. They were largely male (81.8% vs. 16.6% female) and made up of 48.6% Non-Hispanic Whites, 18.2% Hispanic, and 6.2% Non-Hispanic Black. Two-thirds of patients were within the [25-54] years age group, broken down as 20.4%, 24.8% and 22.1% in the 25-34, 35-44, and 45-54 years age group respectively. Persons in the ≥65 age group also represented a sizable proportion at 7.3%. The patients were mostly admitted from an Emergency Department (61.2%), followed by routine/standard admissions (22.2%). While they were for the most part discharged home (81.7%), 7.2% were released to a home care facility, 7.9% to another type of facility, and 0.7% died during their stay in the hospital. As for the geographical distribution, 38.9% were admitted in the West, 24.6% in the South, 19.5% in the Midwest, and 17% in the Northeast United States. Furthermore, 88.6% were admitted in a hospital in urban settings vs. 11.2% in rural settings. The common injury sites were lower and upper extremities (52.6%), multiple locations (14.2%), trunk (9.3%), and head (8.9%). Of all admissions, 48.4% involved fractures, followed by open wounds (25.7%), internal crush injuries (19.4%), and superficial contusions (10.1%). "Foreign Body Entering through Orifice" (0.5%) and poisoning (2.3%) scored the lowest, while burns (5.8%), dislocations (3.9%), and crushing (5%) were noted as well. The mean length of stay was 4.09 days (95% CI 3.92 - 4.22), while the 95th percentile was ≤13 days. When analyzed by injury site, persons with multiple injuries stayed the longest, averaging 6.21 days (95% CI 5.85 - 6.57) while those with injuries at extremities stayed the shortest, 3.53 days (95% CI 3.42 - 3.65). Patients admitted for burns stayed 7.21 days on average (95% CI 6.52 - 7.9) while those with sprain/strain injuries (2.87 days, 95% CI 2.71 - 3.02) and poisoning (2.92 days, 95% CI 2.69 - 3.16) stayed the shortest. Overall, the mean cost of care (crude 2001-2009) was $10,153 per admission. Viewed from the injury site angle, the "multiple" category was the most costly at $17,518 and "extremity" the lowest ($8,269). Diagnostics of "Foreign Body Entering through Orifice" were the most expensive, costing on average ($17,036), closely followed by "burns" ($16,495), while "poisoning" was the least costly, with a mean cost of $6,077. Using Joinpoint regression modeling, we found an overall annual percentage rate change (APC) decrease (-1.73%) over the course of the study. While this improvement was noted in most study sub-segments, it was reversed for women (1.53%), government insurance (Medicare/Medicaid) recipients (7.72%), and older workers (9.16%). The results also revealed a high annual percentage rate (APC) decrease for Hispanics (-9.65%) for the period 1998-2004, jumping to (-18.65%) from 2007 to 2009. A similar pattern with two models was noted for the younger [18-24] age group where the annual percentage rate decreased constantly by (-2.08%) during the period 1998-2007 and drastically jumped to (-18.34%) from 2007 to 2009. In conclusion, a comprehensive trend analysis of industry-related occupational injuries recorded nationwide within the United States as presented in this study is useful to policy makers in formulating targeted strategies and allocation of resources as needed to address disparities found at various levels. Disparities found in trends observed from a gender angle calls for action to reverse the positive rate recorded for females (1.53%) when compared to males (-2.74%). Similarly, there is a call for action to address the age demographic disparity for older worker, the "≥65" age group exhibiting an alarming rate of occupational injuries (9.16%), bucking an across-the-board general negative trend.

Class of 2011 Abstract / OBJECTIVES: The overall purpose of this study was to describe comorbidities, charges, and mortality associated with inpatient, adult traumatic brain injury (TBI) cases in the United States (US) for the year 2007. METHODS: This was a retrospective cohort analysis of discharge records located in the National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP). Descriptive statistics are provided for comorbidities, charges, and mortality. Logistic regression was performed to find characteristics associated with mortality while multiple regression was used to assess charges. Independent variables included age, injury severity, procedures used, location of TBI, and primary payer. RESULTS: A total of 639,698 TBI cases were found which were associated with 267,061 hospital admissions, over $17 billion in hospital charges, and 20,620 deaths in the year 2007.Most common comorbidities were essential hypertension, sprains and strains of the back, tobacco use, fluid and electrolyte disorders, and alcohol-related disorders. Characteristics associated with increased mortality and charges included New Injury Severity Score (NISS) over 10, involvement of a firearm, falls, motor vehicle traffic, and intubation. CONCLUSION: The current study gives the most current picture of inpatient adult TBI cases throughout the US. Future research is warranted to ensure that optimal outcomes are being attained in this vulnerable patient population.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.

Class of 2012 Abstract / Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally-representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.

Class of 2011 Abstract / OBJECTIVES: To assess the role of patient, payer, clinical and disease-related factors in charges and mortality among adult inpatient cases of polycythemia vera in the United States from 2004 to 2008. METHODS: This retrospective cohort study utilized hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) five consecutive years from 2004 to 2008. RESULTS: There were a total of 156,490 episodes of care involving polycythemia vera between 2004 and 2008. Average age upon admission was 65.94 years (±16.03), with 56% of cases being male (n=87,662). The mean length of stay was 5.14 days (±5.31) and inpatient mortality occurred in 3.1% of cases (n=4,927). The mean number of procedures performed was 1.43 (±2.08) and the mean number of diagnoses on record was 9.56 (±3.86). Charges for each episode of care averaged $32,620 (±42,801), summing to a national bill of $5.02 billion (2010 dollars) over the five-year time horizon. Higher charges were associated with longer length of stay, larger hospital bed size, urban hospital location, teaching status, increased number of diagnoses and procedures, private payer, Western U.S. region, and higher income bracket. Increased mortality was associated with increased age, increased number of diagnoses and procedures, self pay, payer other than Medicare, Medicaid, private or self, and the comorbidities of congestive heart failure, coagulopathy, and fluid/electrolyte disorders. CONCLUSION: Polycythemia vera is associated with considerable burden of illness.

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