运用新颖的图分析方法描述新西兰轻度创伤性脑损伤患者在医疗保健途径中的就诊流程。

Describing the patient journey through healthcare pathways following mild traumatic brain injury in New Zealand using novel Graph analysis.

机构信息

Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand.

Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand.

出版信息

Brain Inj. 2023 Sep 19;37(11):1294-1304. doi: 10.1080/02699052.2023.2230878. Epub 2023 Jul 4.

DOI:10.1080/02699052.2023.2230878

PMID:37403290

Abstract

AIM

To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand.

METHODS

Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient's injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics' effect on healthcare outcomes were evaluated.

RESULTS

In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12-185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims.

CONCLUSIONS

Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended.

摘要

目的

确定新西兰轻度创伤性脑损伤（mTBI）患者的治疗提供者序列和医疗路径特征及结果。

方法

利用国家医疗保健数据（患者的损伤和提供的服务）分析总 mTBI 成本和关键路径特征。图形分析产生了具有多个预约的索赔的治疗提供者类型序列，并比较了医疗结果（成本和退出路径的时间）。评估了关键路径特征对医疗结果的影响。

结果

在两年内，55494 份接受的 mTBI 索赔在四年内使 ACC 花费了 93647261 美元。对于有多个预约的索赔（36%），医疗路径中位数为 49 天（IQR，12-185）。89 种治疗提供者类型产生了 3396 种不同的提供者序列，其中 25%仅为全科医生（GP），13%为急诊到 GP（ED-GP），5%为 GP 到脑震荡服务（GP-CS）。具有较短退出时间和较低成本的路径在初次就诊时具有正确的 mTBI 诊断。收入维持占成本的 52%，但仅发生在 20%的索赔中。