Chronic Disease Surveillance Division, National Institute of Public Health of Québec, Québec, Canada.
J Bone Miner Res. 2013 Feb;28(2):360-71. doi: 10.1002/jbmr.1756.
The purposes of this study were to assess direct medical resource utilization related to the treatment of nonvertebral osteoporotic fractures within 1 year postfracture and to evaluate whether age impacts resource utilization. A previously-validated algorithm for physician claims databases identified 15,327 women aged 50 years or older with incident fracture at nonvertebral osteoporotic sites between January 1, 2004 and December 31, 2005. Administrative databases of the health services available to all residents in Quebec served to study fracture-related health resource utilization in the year after fracture. Data were linked by a unique personal identifier, creating a longitudinal cohort of all fracture cases for health resource utilization. The proportions of fractures treated by open reduction, closed reduction, immobilization or follow-up by an orthopedic surgeon (OS) were evaluated. The mean number of claims for consultation with an OS or other clinicians in inpatient and outpatient visits, the hospitalization rate and length of stay (LOS) were assessed. Hip/femur fractures represented the highest rate of resource utilization because the majority of them required surgery (91.1%) and hospitalization (94.5%) with a mean (median) LOS of 39.2 (31) days. However, other nonvertebral fracture types needed significant clinical care related to surgery (27.9%), follow-up consultation with an OS (77.6%), and hospitalization (27.3% of total LOS). Even pelvic fractures, which often do not require surgical treatment, commanded high resource utilization due to the high hospitalization rate (67.4%) with mean (median) LOS of 34.2 (26) days. Moreover, age was an important determinant of health resource utilization, being associated with an increased number of visits to other physicians, hospitalization, and length of hospitalization (LOS), admissions to long term care (LTC), and death. Osteoporosis-related fractures accounted for substantial healthcare resource utilization. With an aging population and increased prevalence of fractures, strategies for osteoporosis management need to be introduced to reduce the healthcare burden.
本研究旨在评估与非椎体骨质疏松性骨折后 1 年内治疗相关的直接医疗资源利用情况，并评估年龄是否影响资源利用。一种先前经过验证的医师索赔数据库算法，在 2004 年 1 月 1 日至 2005 年 12 月 31 日期间，确定了 15327 名年龄在 50 岁及以上的女性在非椎体骨质疏松性部位发生了非椎体骨质疏松性骨折。魁北克所有居民可获得的卫生服务的行政数据库用于研究骨折后一年内与骨折相关的卫生资源利用情况。通过唯一的个人标识符对数据进行链接，为所有骨折病例创建了一个卫生资源利用的纵向队列。评估了接受切开复位、闭合复位、固定或骨科医生（OS）随访治疗的骨折比例。评估了与 OS 或其他临床医生进行门诊和住院就诊的咨询次数、住院率和住院时间（LOS）的平均值。髋/股骨骨折的资源利用率最高，因为大多数需要手术（91.1%）和住院（94.5%），平均（中位数） LOS 为 39.2（31）天。然而，其他非椎体骨折类型也需要进行重要的手术相关临床治疗（27.9%）、OS 随访咨询（77.6%）和住院治疗（占总 LOS 的 27.3%）。即使是骨盆骨折，通常不需要手术治疗，但由于高住院率（67.4%），平均（中位数） LOS 为 34.2（26）天，因此仍需要大量的医疗资源。此外，年龄是医疗资源利用的一个重要决定因素，与其他医生就诊次数、住院、住院时间（LOS）、长期护理（LTC）入院和死亡次数增加有关。骨质疏松性骨折导致了大量的医疗资源利用。随着人口老龄化和骨折发病率的增加，需要引入骨质疏松症管理策略，以减轻医疗负担。
