Wise Kelsey, Blaschke Breanna L, Parikh Harsh R, Gorman Tiffany, Casnovsky Lauren, McMilan Logan J, Flagstad Ilexa, Okelana A Bandele, Horst Patrick, Cunningham Brian P
Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA.
Geriatr Orthop Surg Rehabil. 2020 Dec 3;11:2151459320976533. doi: 10.1177/2151459320976533. eCollection 2020.
Geriatric hip fractures are a major, costly public health issue, expected to increase in incidence and expense with the aging population. As healthcare transitions towards value-based care, understanding cost drivers of hip fracture treatment will be necessary to perform adequate risk adjustment. Historically, cost has been variable and difficult to determine. This study was purposed to identify variables that can predict the overall cost of care for geriatric intertrochanteric (IT) hip fractures and provide a better cost prediction to ensure the success of future bundled payment models.
A retrospective review of operatively-managed geriatric hip fractures was performed at single urban level I academic trauma center between 2013 and 2017. Patient variables were collected via the electronic medical record (EMR) including CCI, ACCI, ASA, overall length of stay (LOS), AO/OTA fracture classification and demographics. Direct and indirect costs were calculated by activity-based costing by the hospital's accounting software. Multivariable linear regression models evaluated which parameters predicted total inpatient cost of care.
The mean cost of care was $19,822, ranging from $9,128 to $64,211. Critical care comprised 16.9% of total costs, followed by implant costs (13.6%), and nursing costs (12.6%). Regression analysis identified both ASA ( < 0.01) and ACCI ( = 0.01) as statistically significant associative parameters, but only LOS ( = 0.77) as a strong correlative measure for inpatient care cost.
This study found no correlation between ACCI or ASA and the total inpatient cost of care in isolated intertrochanteric geriatric hip fractures, suggesting that the inpatient episode-of-care costs cannot be accurately predicted by the patient demographics/comorbidities alone. Future bundled care payment models would have to be adjusted to account for variables beyond just patient characteristics.
Diagnostic Level IV.
老年髋部骨折是一个重大的、成本高昂的公共卫生问题，预计随着人口老龄化，其发病率和费用将会增加。随着医疗保健向基于价值的医疗转变，了解髋部骨折治疗的成本驱动因素对于进行充分的风险调整至关重要。从历史上看，成本一直存在差异且难以确定。本研究旨在确定能够预测老年股骨转子间（IT）髋部骨折总体护理成本的变量，并提供更好的成本预测，以确保未来捆绑支付模式的成功。
对2013年至2017年期间在一家城市一级学术创伤中心接受手术治疗的老年髋部骨折患者进行回顾性研究。通过电子病历（EMR）收集患者变量，包括CCI、ACCI、ASA、总住院时间（LOS）、AO/OTA骨折分类和人口统计学信息。直接和间接成本通过医院会计软件采用作业成本法计算。多变量线性回归模型评估哪些参数可预测住院护理的总成本。
护理的平均成本为19,822美元，范围从9,128美元至64,211美元。重症监护占总成本的16.9%，其次是植入物成本（13.6%）和护理成本（12.6%）。回归分析确定ASA（<0.01）和ACCI（=0.01）均为具有统计学意义的关联参数，但只有LOS（=0.77）是住院护理成本的强相关指标。
本研究发现，在单纯的老年股骨转子间髋部骨折中，ACCI或ASA与住院护理总成本之间无相关性，这表明仅通过患者人口统计学特征/合并症无法准确预测住院护理期间的成本。未来的捆绑护理支付模式必须进行调整，以考虑除患者特征之外的变量。
诊断性研究IV级。
