French Dustin D, Campbell Robert R, Sabharwal Sunil, Nelson Audrey L, Palacios Polly A, Gavin-Dreschnack Deborah
VISN-8 Patient Safety Center of Inquiry, James A. Haley VA Medical Center, 13000 Bruce B Downs Boulevard (118M) Tampa, Florida 33612, USA.
J Spinal Cord Med. 2007;30(5):477-81. doi: 10.1080/10790268.2007.11754581.
BACKGROUND/OBJECTIVE: Recurring annual costs of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on health care systems, but information on costs of SCI care beyond the acute and initial postacute phase is sparse. The objective of this study was to establish a frame of reference and estimate of the annual direct medical costs associated with health care for a sample of patients with chronic SCI (ie, > 2 years after injury).
Patients were recruited from 3 Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross-referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific health care costs in VHA. Descriptive statistical analysis of annual DSS-NDE cost of patients with SCI (N = 675) for fiscal year (FY) 2005 by level and completeness of injury was conducted.
Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 patients with SCI exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. Two hundred thirty-three of the 675 patients with SCI who were hospitalized over the study period accounted for a total of 378 hospital discharges, costing in excess of $7.19 million. This approximated a cost of outpatient care received of $7.28 million for our entire sample.
The comprehensive nature of health care delivery and related cost capture for people with chronic SCI in the VHA provided us the opportunity to accurately determine health care costs for this population. Future SCI postacute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization.
背景/目的：慢性脊髓损伤（SCI）患者每年反复产生的护理费用给医疗系统带来了巨大的经济负担，但关于SCI护理在急性期和急性后期之后的费用信息却很匮乏。本研究的目的是建立一个参考框架，并估算慢性SCI患者样本（即受伤超过2年）的年度直接医疗费用。
从3个退伍军人健康管理局（VHA）的SCI治疗机构招募患者；将患者的基线信息与决策支持系统（DSS）的国家数据提取物（NDE）进行交叉参考，以获取VHA中患者特定的医疗费用。对2005财年675例SCI患者的年度DSS-NDE费用按损伤程度和完整性进行描述性统计分析。
675例SCI患者2005财年的年度（住院和门诊）直接医疗总费用超过1447万美元，即每位患者21450美元。年度平均总费用从颈髓完全损伤患者的28334美元到胸髓不完全损伤患者的16792美元不等。在研究期间住院的675例SCI患者中有233例共出院378次，费用超过719万美元。这接近我们整个样本接受的门诊护理费用728万美元。
VHA为慢性SCI患者提供的全面医疗服务和相关成本记录，使我们有机会准确确定该人群的医疗费用。未来SCI急性后期护理费用分析应考虑对再住院高风险患者进行病例组合调整。
