Evaluation of Pedestrian Injury and its Associated Hospital Costs in San Francisco
Principal Investigators: Rochelle Dicker, MD, Wendy Max, PhD; Co-Investigator: Dahianna Lopez, RN
Summary of Project:
The purpose of this study was to carry out a detailed analysis of pedestrian direct medical cost and its relationship to the location of pedestrian injury. Pedestrian injury creates a tremendous public funding burden and targeting identified "high cost areas" with effective countermeasures could save lives and reduce cost. Cost data will provide city planners, safety engineers, and other stakeholders the ability to make an economic case for safety and injury prevention.
A retrospective analysis was conducted of billing records of 694 auto-versus-pedestrian victims treated at San Francisco General Hospital, our city's Level I Trauma Center in the sample year 2004. Total cost was computed using cost to charge ratios for hospital and ambulance fees and actual costs of professional fees. "Price tags" were assigned to each city district.
In this sample year of 2004, the total cost of injury was $9.8 million, while the total charge was $20.8 million. 90% of victims resided in our city. 31% were admitted and cost of their care accounted for 76% of the total. Admitted patients were older than patients who were discharged directly from the Emergency Department (47 vs. 38 years; t = 5.45, p = 0.00). 76% of the total costs were publicly funded (e.g., Medicare, MediCal and other public funding sources).
In a climate of limited resources, this kind of roadmap outlines the three regions that could most benefit from countermeasures from both an injury prevention and cost containment standpoint. Cost-driven surveillance is useful in city strategic planning of cost effective and life-saving pedestrian injury countermeasures.
A detailed analysis of four other years is currently in progress. In March of 2010, results from the five-year analysis (2004-2008) will be released, including the price tags per city district.
From Abstract accepted by Western Trauma Association: Dicker RA, Lopez D, Max W, Knudson MM, Pepper M, Crane I. (2009)
Bridging Research and Policy
The Injury Center's Prevention Director, Dahianna Lopez, RN, MSN, MPH holds the Public Health seat on the Pedestrian Safety Advisory Committee (PSAC) and has recently been elected Secretary. The committee publicly represents the SF Board of Supervisors on pedestrian issues. We encourage members of the public to participate in the monthly meetings at City Hall. For more information, please visit: Pedestrian Safety Advisory Committee
