Kates Stephen L, Blake Deidre, Bingham Karilee W, Kates Olivia S, Mendelson Daniel A, Friedman Susan M
University of Rochester School of Medicine & Dentistry, Department of Orthopaedics & Division of Geriatrics, Highland Hospital, Rochester, NY, USA.
Geriatr Orthop Surg Rehabil. 2010 Sep;1(1):15-21. doi: 10.1177/2151458510382231.
This study describes the financial impact of an organized hip fracture program for elderly patients age 65 years and older.
This is a retrospective study of 797 fractures in 776 consecutive patients over a 50-month period (May 2005 to July 2009) treated in an organized hip fracture program for the elderly identified from a quality management database. Financial, demographic, and quality-of-care data were collected. The length of hospital stay, in-hospital complications, and Charlson comorbidity scores were collected from patient records, and all data were evaluated using standard statistical methods.
261-bed community-based, university-affiliated teaching hospital in an urban setting with a catchment area of approximately 1 million persons. This is a level 3 trauma center.
The average total net revenue per hip fracture was $12 159, with an average total cost to hospital of $8264. Physicians' fees consisted of fees collected by surgeons, anesthesiologists, medical specialty consultants, and consulting geriatricians and averaged $2024 per case. Thus, the average hospital charge to payers was $15 188. Compared to Agency for Healthcare Research and Quality average inpatient hospital costs in 2005 of $33 693, a savings of more than $18 000 was realized per patient. The average length of stay was 4.6 days, markedly less than the national average of 6.2 days.
This organized geriatric fracture care model with geriatrics comanagement resulted in significant cost savings over a 50-month period, with associated increased quality. With an estimated 330 000 hip fractures annually in the United States, a large cost savings could potentially be realized if this model were more widely applied.
本研究描述了针对65岁及以上老年患者的有组织的髋部骨折治疗项目所产生的财务影响。
这是一项回顾性研究，对2005年5月至2009年7月这50个月期间，从质量管理数据库中识别出的、参与有组织的老年髋部骨折治疗项目的776例连续患者的797处骨折进行研究。收集了财务、人口统计学和护理质量数据。从患者记录中收集住院时间、院内并发症和查尔森合并症评分，所有数据均采用标准统计方法进行评估。
一家位于城市、拥有261张床位的社区型大学附属医院，服务人口约100万。这是一家三级创伤中心。
每例髋部骨折的平均总净收入为12159美元，医院的平均总成本为8264美元。医师费用包括外科医生、麻醉师、医学专科顾问和老年病咨询医生收取的费用，平均每例为2024美元。因此，医院向支付方收取的平均费用为15188美元。与医疗保健研究与质量局2005年平均住院医院成本33693美元相比，每位患者节省了超过18000美元。平均住院时间为4.6天，明显低于全国平均的6.2天。
这种有老年病共同管理的有组织的老年骨折护理模式在50个月期间实现了显著的成本节约，同时提高了护理质量。据估计，美国每年有33万例髋部骨折，如果更广泛地应用这种模式，可能会实现大幅成本节约。
