Injury Recidivism Rate and Cost Analysis: An Ounce of Prevention

An Ounce of Prevention:  Comparing the Cost of Treating Victims of Interpersonal Violence to the Cost of a Violence Prevention Program at an Urban Trauma Center

 A cost analysis has been done of the Wraparound Project by David Grunwald, a medical student who is in the UC San Francisco Joint Medical Program with UC Berkeley.  His hypothesis is that the cost to treat patients with injuries due to interpersonal violence each year is significantly higher than the cost to run the Wraparound Project at San Francisco General Hospital (SFGH) Trauma Center.

His objectives for the study include:  1.) Estimate the average cost to treat a victim of intentional violence at SFGH; 2.) Compare these costs to those of the Wraparound Project to determine if Wraparound can potentially provide a cost savings to SFGH; 3.) Data from this type of analysis is of value to community, government and financial stakeholders, and may be useful to help guide future policy related to violence prevention. Included in the study are 39 patients whose injuries necessitated trauma activation at SFGH between 2006 and 2007 and who were eligible to become Wraparound clients. Hospital service utilization data were obtain from SFGH administrative database specifically the hospital's inpatient utilization databases and the physicians' professional fee databases.  Charges for most post-operative visits were included in the professional fees. Charges included in the study were limited to imaging, surgical procedures, anesthesia, room charges and professional fees. This study uses charges (billed amounts) instead of costs.  Charges represent the full amount billed while costs represent the value of the resources used to produce the services.

• Average charge per patients (n=39):  $108,361 (95% confidence interval 70,384 to 146,338)
• Median:  $75,076
• Range: $10,024 - 629,525
• Standard deviation:  $121,003

• Shooting and stabbings make up the vast majority of causes of interpersonal violence that result in trauma activations.
• Extrapolating the average cost to treat each patient to the 442 shooting and stabbing trauma activations from 2007 would give a total charge amount of $47,895,831.
• Extrapolating the median would give a total charge amount of $33,183,636 for the 442 patients in 2007.

  SFGH Wraparound Project Annual Budget 2007

              Personnel Expenses                  $97,614
             Non-Personnel Expenses           11,619
            Total Expenses:                        $109, 233 

In addition to improving morbidity and mortality outcomes, this preliminary data shows that the Wraparound Project would provide a large cost savings to SFGH and to the City of San Francisco.

Wraparound project's annual cost of $109,223 is only slightly larger than the average per injury cost of $108,361.  These data show that Wraparound will be cost neutral once it prevents one subsequent injury and will have a cost benefit once it prevents two injuries.

There is an ever increasing interest in finding ways to cut health care costs, especially in the midst of current challenging economic times.  This type of violence prevention is a promising example of how health care agencies and local governments may be able to both cut costs and at the same time improve the health and well-being of high-risk individuals.

 From David Grunwald's poster presented January 14, 2009.  Research presentation will be at  the JMP Master's Research Symposium at UC Berkeley on 2/15/10.