Ishizaki Tatsuro, Imanaka Yuichi, Oh Eunhwan, Kuwabara Kazuaki, Hirose Masahiro, Hayashida Kenshi, Harada Yoshiaki
Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501 Japan.
Health Policy. 2004 Aug;69(2):179-87. doi: 10.1016/j.healthpol.2003.12.018.
This study examined the association of resource use with comorbidity status and patient age among hip fracture patients who underwent surgical treatment.
We used a database from the Voluntary Hospitals of Japan Quality Indicator Project that involved 10 privately owned leading teaching hospitals in Japan.
Four of these hospitals in Japan.
We selected 778 operable hip fracture patients aged 65 or older who were admitted to these hospitals between January 1996 and August 2000 (mean age: 80.3 +/- 7.3 years).
A linear mixed model was performed to identify factors associated with the resource use, such as total length of stay (LOS), LOS before surgery, LOS after surgery, total hospital charges, charges for diagnostic examinations, charges for surgery, and length of theater time, among operable hip fracture patients.
The mean LOS was 45.9 days, and the mean total hospital charges were US dollars 14,495.0. Results from linear mixed models revealed that higher age was significantly associated with shorter length of theater time (P < 0.01), and that the presence of comorbidity among hip fracture patients was significantly associated with longer total LOS (P < 0.01), longer LOS after surgery (P < 0.001), higher charges for diagnostic examinations (P < 0.001), and shorter length of theater time (P < 0.01).
These results suggest that the presence of comorbidity among operable hip fracture patients requires greater resource use during their hospital stay, but higher age is not significantly associated with greater resource use at all.
本研究调查了接受手术治疗的髋部骨折患者的资源使用情况与共病状态及患者年龄之间的关联。
我们使用了日本自愿医院质量指标项目的数据库，该项目涉及日本10家私立领先教学医院。
日本的其中4家医院。
我们选取了1996年1月至2000年8月期间入住这些医院的778例65岁及以上可手术治疗的髋部骨折患者（平均年龄：80.3±7.3岁）。
采用线性混合模型来确定可手术治疗的髋部骨折患者中与资源使用相关的因素，如住院总时长、术前住院时长、术后住院时长、医院总费用、诊断检查费用、手术费用和手术时间。
平均住院总时长为45.9天，平均医院总费用为14,495.0美元。线性混合模型的结果显示，年龄较大与手术时间较短显著相关（P<0.0），髋部骨折患者存在共病与住院总时长较长显著相关（P<0.01）、术后住院时长较长显著相关（P<0.001）、诊断检查费用较高显著相关（P<0.001）以及手术时间较短显著相关（P<0.01）。
这些结果表明，可手术治疗的髋部骨折患者存在共病时，住院期间需要更多资源，但年龄较大与资源使用增加并无显著关联。
