Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department Trauma TopCare, ETZ Hospital, Tilburg, The Netherlands.
BMC Geriatr. 2020 Oct 21;20(1):417. doi: 10.1186/s12877-020-01825-z.
With the ageing population, the number of older trauma patients has increased. The aim of this study was to assess non-surgical health care costs of older trauma patients and to identify which characteristics of older trauma patients were associated with high health care costs.
Trauma patients aged ≥65 years who were admitted to a hospital in Noord-Brabant, the Netherlands, were included in the Brabant Injury Outcome Surveillance (BIOS) study. Non-surgical in-hospital and up to 24- months post-hospital health care use were obtained from hospital registration data and collected with the iMTA Medical Consumption Questionnaire which patients completed 1 week and 1, 3, 6, 12 and 24 months after injury. Log-linked gamma generalized linear models were used to identify cost-driving factors.
A total of 1910 patients were included in the study. Mean total health care costs per patient were €12,190 ranging from €8390 for 65-69 year-olds to €15,550 for those older than 90 years. Main cost drivers were the post-hospital costs due to home care and stay at an institution. Falls (72%) and traffic injury (15%) contributed most to the total health care costs, although costs of cause of trauma varied with age and sex. In-hospital costs were especially high in patients with high injury severity, frailty and comorbidities. Age, female sex, injury severity, frailty, having comorbidities and having a hip fracture were independently associated with higher post-hospital health care costs.
In-hospital health care costs were chiefly associated with high injury severity. Several patient and injury characteristics including age, high injury severity, frailty and comorbidity were associated with post-hospital health care costs. Both fall-related injuries and traffic-related injuries are important areas for prevention of injury in the older population.
随着人口老龄化，老年创伤患者的数量有所增加。本研究旨在评估老年创伤患者的非手术性医疗保健费用，并确定哪些老年创伤患者的特征与高医疗保健费用相关。
纳入荷兰北布拉班特省一家医院的年龄≥65 岁的创伤患者参加 Brabant Injury Outcome Surveillance（BIOS）研究。从医院登记数据中获取非手术性住院和出院后 24 个月内的医疗保健使用情况，并通过 iMTA Medical Consumption Questionnaire 收集患者在受伤后 1 周、1、3、6、12 和 24 个月时的信息。使用对数链接伽马广义线性模型来确定成本驱动因素。
共纳入 1910 例患者。每位患者的平均总医疗保健费用为 12190 欧元，65-69 岁患者为 8390 欧元，90 岁以上患者为 15550 欧元。主要成本驱动因素是因家庭护理和机构入住而产生的出院后费用。跌倒（72%）和交通伤（15%）对总医疗保健费用的贡献最大，尽管创伤原因的费用因年龄和性别而异。在损伤严重程度高、虚弱和合并症的患者中，住院费用尤其高。年龄、女性、损伤严重程度、虚弱、合并症和髋部骨折与较高的出院后医疗保健费用独立相关。
住院医疗保健费用主要与损伤严重程度相关。包括年龄、高损伤严重程度、虚弱和合并症在内的多个患者和损伤特征与出院后医疗保健费用相关。跌倒相关损伤和交通相关损伤都是老年人群中预防损伤的重要领域。
