KPM Center for Public Management, University of Bern, Bern, Switzerland.
Swiss Institute of Translational and Entrepreneurial Medicine, Bern, Switzerland.
Health Serv Res. 2021 Dec;56 Suppl 3(Suppl 3):1370-1382. doi: 10.1111/1475-6773.13734. Epub 2021 Sep 7.
To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.
Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).
We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death.
DATA COLLECTION/EXTRACTION METHODS: We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.
Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.
Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
在七个发达国家中，确定并探讨髋部骨折患者临终前关键卫生服务的使用和支出差异。
国际成本、结局和关怀需求合作研究（ICCONIC）汇总的住院和门诊医疗保健部门的个体水平索赔数据。
我们回顾性地分析了来自澳大利亚、加拿大、英国、德国、新西兰、西班牙和美国的急性医院护理、急诊、门诊初级保健和专科医生就诊以及门诊药物的使用和支出情况。在过去的 30、90 和 180 天内，比较了各国之间和各国内部的支出和使用模式。我们采用线性回归模型来衡量各国内部和各国之间的年龄和性别特定影响。此外，我们分析了以医院为中心的情况，即住院天数和死亡地点。
资料收集/提取方法：我们确定了在 2016 年发生髋部骨折并在入院后 12 个月内死亡的患者。
资源使用、成本和医院死亡比例差异很大，在英国和西班牙较高，而在新西兰较低。在加拿大、德国、西班牙和美国，随着年龄的增长，住院天数显著减少。在加拿大、德国和美国，女性在接近死亡日期时的住院费用明显较低。在急诊、门诊护理和药物使用和支出方面，年龄梯度和性别效应的影响较小。
在七个国家中，我们发现髋部骨折患者临终关怀存在重要差异，其中一些差异可以用性别和年龄来解释。我们的工作提供了重要的见解，可能有助于正在进行的关于医疗保健系统公平性、效率和报销的卫生政策讨论。
