Harvard Combined Orthopaedics Residency Program, Boston, Massachusetts.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Bone Joint Surg Am. 2019 Jul 17;101(14):1245-1252. doi: 10.2106/JBJS.18.01114.
Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden.
We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury.
There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001).
Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.
关于矫形创伤对患者经济健康的影响知之甚少。我们假设，一些遭受肌肉骨骼创伤的患者在治疗过程中会经历相当大的经济困难，我们还评估了与个人经济负担增加相关的因素。
我们调查了 2016 年至 2017 年间在 2 家美国外科医师学会一级创伤中心完成肌肉骨骼损伤治疗后的 393 名连续患者中的 236 名（60%的应答率）。使用了 2 种经过验证的测量方法（财务负担综合评分和二分担忧评分）来评估患者因受伤而经历的经济困难程度。
研究中有 236 名参与者，平均年龄为 56.3 岁（19 至 94 岁），48.7%的患者为男性。在 236 名患者中，97.9%有医疗保险，但平均财务负担综合评分（标准差）为 2.4±2.2（0 表示低，6 表示高）。在这项研究中，25.0%的患者对因受伤而导致的财务问题感到非常担忧。54%的患者用储蓄支付医疗费用，23%的患者借钱或贷款。23%的患者拖欠其他账单。57%的患者普遍削减开支。财务负担综合评分较高的患者，其财务担忧程度显著增加（比值比[OR]，1.8[95%置信区间（CI），1.5 至 2.2]；p<0.001）。与经济困难增加相关的因素包括高免赔额健康计划保险（系数，0.3[95%CI，0.002 至 0.528]；p=0.048）、医疗补助保险（系数，0.6[95%CI，0.342 至 0.863]；p<0.001）、未完成高中学业（系数，0.475[95%CI，0.033 至 0.918]；p=0.035）、手术次数增加（系数，0.067[95%CI，0.005 至 0.129]；p=0.035）和以前的医疗或学生贷款（系数，0.769[95%CI，0.523 至 1.016]；p<0.001）。
尽管我们的研究中有很高的保险率，但患有矫形创伤的患者仍然存在较高的担忧和经济困难。询问经济困难情况可能有助于识别那些个人经济负担较重的患者，并可能促进额外的社会支持和服务的分配。
