Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2019 Sep;33(9):e345-e351. doi: 10.1097/BOT.0000000000001501.
To calculate the revenue generated for injury- and noninjury-related services after the initial injury event in an orthopaedic trauma population.
Retrospective cohort study.
Single Level 1 trauma center.
Four hundred forty adult trauma patients treated operatively for spine, pelvis, and/or upper or lower extremity fractures with ≥1 night stay.
Operative fracture management.
Revenue for follow-up care and for noninjury-related indications for 24 months.
Most patients returned for follow-up (92.3%), generating 6704 visits with professional and technical collections of $8,135,022 and $37,292,722, respectively, per 1000 unique patients. The greatest revenue was from rehabilitation services. Patients were less likely to return if they resided outside adjacent counties [odds ratio (OR) = 0.16], experienced a complication (OR = 0.38), or were older (OR per 10-year increase: 0.66) (all P < 0.0001). More than 70% of trauma patients were new to our system, accounting for 33% of all subsequent noninjury-related visits, most for primary care (25.6%). Male patients [OR = 3.28, 95% confidence interval (CI), 1.08-9.93], nonwhites (OR = 3.41; 95% CI, 1.41-8.28), and patients residing near the trauma center (OR = 16.1, 95% CI, 2.13-121) were more likely to return (P < 0.0001). Realized noninjury-related professional and technical revenue was $506 per operative orthopaedic trauma case.
Demographics and outcomes predict likelihood of follow-up. Rehabilitation services account for the greatest revenue per patient. The greatest number of return visits was for primary care services; awareness of such services, especially in men and in those residing near the hospital system, could improve retention.
计算骨科创伤患者初次损伤事件后与损伤相关和非损伤相关服务的收入。
回顾性队列研究。
单一级创伤中心。
440 名成年创伤患者，因脊柱、骨盆和/或上下肢骨折接受手术治疗，住院时间≥1 晚。
手术骨折管理。
24 个月内随访和非损伤相关适应证的收入。
大多数患者返回随访（92.3%），每位患者随访就诊 6704 次，专业技术收费分别为 8135022 美元和 37292722 美元。收入最多的是康复服务。如果患者居住在邻近县以外（比值比[OR] = 0.16）、发生并发症（OR = 0.38）或年龄较大（每增加 10 岁 OR：0.66）（均 P < 0.0001），则不太可能返回。超过 70%的创伤患者是我们系统的新患者，占所有非损伤相关就诊的 33%，其中大部分是初级保健就诊（25.6%）。男性患者（OR = 3.28，95%置信区间[CI]，1.08-9.93）、非白人（OR = 3.41；95% CI，1.41-8.28）和居住在创伤中心附近的患者（OR = 16.1，95% CI，2.13-121）更有可能返回（P < 0.0001）。实现的非损伤相关专业技术收入为每例骨科创伤手术 506 美元。
人口统计学和结局可预测随访的可能性。康复服务每例患者的收入最高。返回就诊最多的是初级保健服务；提高对这些服务的认识，特别是在男性和医院系统附近居住的人群中，可以提高患者的保留率。
