Rittenhouse Katelyn, Harnish Carissa, Gross Brian, Rogers Amelia, Miller Jo Ann, Chandler Roxanne, Rogers Frederick B
From the Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
J Trauma Acute Care Surg. 2015 Feb;78(2):409-14. doi: 10.1097/TA.0000000000000513.
To date, there are almost 500 accountable care organizations (ACOs) across the United States emphasizing cost-effective care. Readmission largely impacts health care cost; therefore, we sought to determine factors associated with geriatric trauma readmissions (recidivism) within our institution.
All admissions from 2000 to 2011 attributed to patients 65 years or older at our Level II trauma center, recently verified by Medicare as an ACO, were queried. Patients were classified as recidivist or nonrecidivist. The first admissions of recidivist patients were compared with the nonrecidivist admissions with respect to sex, age, race, primary insurance, admission Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), hospital length of stay, mechanism of injury (MOI), preexisting conditions, and discharge destination. Factors found to be significant predictors of recidivism in univariate analyses were subsequently incorporated into a multivariate logistic regression model. In addition, the second admission's MOI was compared with the first admission's MOI, and the proportion of first, second, and third admissions attributed to falls was calculated. A p < 0.05 was significant.
Between 2000 and 2011, a total of 4,963 unique patients were admitted to the trauma center at 65 years or older. This population was composed of 287 recidivists (5.8%) and 4,676 nonrecidivists (94.2%). When placed in a multivariate logistic regression, female sex, admission GCS score of 15, history of head trauma, and preexisting pulmonary disease were identified as significant predictors of recidivism. A trend toward increasing proportion of injuries attributed to falls was found with each subsequent trauma admission (81.5% [234 of 287] of first admissions, 88.2% [253 of 287] of second admissions, and 90.5% [19 of 21] of third admissions).
Our study identifies specific factors that should be targeted by social service and prevention resources to inhibit recidivism in the elderly. In the brave new world of ACOs, trauma centers must identify high-risk populations for the consumption of limited resources.
Care management study, level IV. Prognostic study, level III.
截至目前，美国有近500个负责医疗组织（ACO），强调成本效益高的医疗服务。再入院对医疗成本有很大影响；因此，我们试图确定我们机构内老年创伤再入院（累犯）相关的因素。
查询了2000年至2011年期间在我们二级创伤中心收治的65岁及以上患者的所有入院记录，该中心最近被医疗保险确认为ACO。患者被分为累犯或非累犯。将累犯患者的首次入院情况与非累犯患者的入院情况在性别、年龄、种族、主要保险、入院格拉斯哥昏迷量表（GCS）评分、损伤严重程度评分（ISS）、住院时间、损伤机制（MOI）、既往疾病和出院目的地等方面进行比较。在单变量分析中发现的累犯的显著预测因素随后被纳入多变量逻辑回归模型。此外，比较了第二次入院的MOI与第一次入院的MOI，并计算了第一次、第二次和第三次入院中因跌倒导致的比例。p<0.05具有显著性。
2000年至2011年期间，共有4963名65岁及以上的独特患者入住创伤中心。该人群包括287名累犯（5.8%）和4676名非累犯（94.2%）。在多变量逻辑回归分析中，女性、入院GCS评分为15、头部外伤史和既往肺部疾病被确定为累犯的显著预测因素。随着每次后续创伤入院，因跌倒导致的损伤比例呈上升趋势（第一次入院的81.5%[287例中的234例]，第二次入院的88.2%[287例中的253例]，第三次入院的90.5%[21例中的19例]）。
我们的研究确定了社会服务和预防资源应针对的特定因素，以抑制老年人的累犯。在ACO这个全新的世界中，创伤中心必须识别出消耗有限资源的高危人群。
护理管理研究，IV级。预后研究，III级。
