Hall Sonĵa E, Hendrie Delia V
School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009.
Aust N Z J Public Health. 2003;27(3):343-51. doi: 10.1111/j.1467-842x.2003.tb00405.x.
To establish the hospital cost and three-month, post-hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined.
Patients who attended the Emergency. Department of a teaching hospital in Perth, Western Australia, were asked to complete a daily diary for three months of all community and informal care they received due to their fall and any associated expenses. Unit costs were collected from various sources and used to estimate the cost of community and informal care. Hospital inpatient costs were estimated using a patient-based costing system.
Seventy-nine patients participated with a total estimated falls-related cost for the three-month period of $316,155 to $333,648 (depending on assumptions used) and a mean cost per patient of between $4,291 and $4,642. The hospital cost accounted for 80%, community costs 16% and personal costs 4% of the total. Of community and personal costs, 60% was spent in the first month. Type of injury was the most significant determinant of hospital and community costs. Extrapolating these figures to the WA population provided an estimate of the total hospital and three-month, post-hospital cost of falls of $24.12 million per year, with $12.1 million funded by the Federal Government, $10.1 million by State/local government and $1.7 million in out-of pocket expenses by patients.
In the acute and immediate post-discharge period, hospital costs accounted for most of the cost of care for older adults discharged to the community after a fall. Community and personal costs, however, were also incurred. The cost estimates provide useful information for planners of hospital and community care for older people who have sustained a fall.
确定老年人跌倒后出院回到社区的医院费用以及出院后三个月的社区和个人费用。同时还研究了这些费用在不同部门产生的时间、发生率及决定因素。
要求前往西澳大利亚珀斯一家教学医院急诊科就诊的患者，就其因跌倒所接受的所有社区和非正规护理以及任何相关费用，填写一份为期三个月的每日日志。从各种来源收集单位成本，并用于估算社区和非正规护理的费用。使用基于患者的成本核算系统估算医院住院费用。
79名患者参与研究，三个月期间与跌倒相关的总费用估计为316,155美元至333,648美元（取决于所采用的假设），每位患者的平均费用在4,291美元至4,642美元之间。医院费用占总费用的80%，社区费用占16%，个人费用占4%。在社区和个人费用中，60%在第一个月支出。损伤类型是医院和社区费用的最主要决定因素。将这些数字推算至西澳大利亚州的人口，得出每年跌倒的医院及出院后三个月的总费用估计为2412万美元，其中1210万美元由联邦政府资助，1010万美元由州/地方政府资助，170万美元为患者自付费用。
在急性和出院后的即时阶段，医院费用占跌倒后出院回到社区的老年人护理费用的大部分。然而，也产生了社区和个人费用。这些费用估计为跌倒的老年人的医院和社区护理规划者提供了有用信息。
