创伤后经济毒性与长期健康结局的多中心评估
Multicenter evaluation of financial toxicity and long-term health outcomes after injury.
作者信息
Scott John W, Anderson Geoffrey A, Conatser Amelia, de Souza Cairo, Evans Emily, Goodwin Zachary, Jakubus Jill L, Kelm Julia, Mekled Iman, Monahan Janessa, Oh Esther J, Oliphant Bryant W, Hemmila Mark R
机构信息
From the Department of Surgery (J.W.S.), Harborview Medical Center, University of Michigan, Ann Arbor, Michigan; Department of Surgery (J.W.S., A.C., C.d.S., Z.G., J.L.J., J.K., I.M., J.M., E.J.O., M.R.H.), Center for Healthcare Outcomes and Policy (J.W.S., E.J.O., B.W.O., M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; University of Michigan Medical School (E.E.); and Department of Orthopedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan.
出版信息
J Trauma Acute Care Surg. 2024 Jan 1;96(1):54-61. doi: 10.1097/TA.0000000000004161. Epub 2023 Oct 23.
BACKGROUND
Despite the growing awareness of the negative financial impact of traumatic injury on patients' lives, the association between financial toxicity and long-term health-related quality of life (hrQoL) among trauma survivors remains poorly understood.
METHODS
Patients from nine trauma centers participating in a statewide trauma quality collaborative had responses from longitudinal survey data linked to inpatient trauma registry data. Financial toxicity was defined based on patient-reported survey responses regarding medical debt, work or income loss, nonmedical financial strain, and forgone care due to costs. A financial toxicity score ranging from 0 to 4 was calculated. Health-related quality of life was assessed using the EuroQol 5 Domain tool. Multivariable regression models evaluated the association between financial toxicity and hrQoL outcomes while adjusting for patient demographics, injury severity and inpatient treatment intensity, and health systems variables.
RESULTS
Among the 403 patients providing 510 completed surveys, rates of individual financial toxicity elements ranged from 21% to 46%, with 65% of patients experiencing at least one element of financial toxicity. Patients with any financial toxicity had worse summary measures of hrQoL and higher rates of problems in all five EuroQol 5 Domain domains ( p < 0.05 for all). Younger age, lower household income, lack of insurance, more comorbidities, discharge to a facility, and air ambulance transportation were independently associated with higher odds of financial toxicity ( p < 0.05 for all). Injury traits and inpatient treatment intensity were not independently associated with financial toxicity.
CONCLUSION
A majority of trauma survivors in this study experienced some level of financial toxicity, which was independently associated with worse risk-adjusted health outcomes across all hrQoL measures. Risk factors for financial toxicity are not related to injury severity or treatment intensity but rather to sociodemographic variables and measures of prehospital and posthospital health care resource utilization. Targeted interventions and policies are needed to address financial toxicity and ensure optimal recovery for trauma survivors.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
背景
尽管人们越来越意识到创伤性损伤对患者生活的负面经济影响，但创伤幸存者中经济毒性与长期健康相关生活质量（hrQoL）之间的关联仍知之甚少。
方法
来自九个创伤中心参与全州创伤质量协作项目的患者，其纵向调查数据与住院创伤登记数据相关联。经济毒性是根据患者报告的关于医疗债务、工作或收入损失、非医疗经济压力以及因费用而放弃治疗的调查回复来定义的。计算了一个范围从0到4的经济毒性评分。使用欧洲五维健康量表工具评估健康相关生活质量。多变量回归模型在调整患者人口统计学、损伤严重程度和住院治疗强度以及卫生系统变量的同时，评估了经济毒性与hrQoL结果之间的关联。
结果
在提供510份完整调查问卷的403名患者中，个体经济毒性因素的发生率在21%至46%之间，65%的患者经历了至少一种经济毒性因素。有任何经济毒性的患者在hrQoL的综合测量方面较差，并且在欧洲五维健康量表的所有五个领域中问题发生率更高（所有p<0.05）。年龄较小、家庭收入较低、缺乏保险、合并症较多、出院到医疗机构以及空中救护车转运与经济毒性的较高几率独立相关（所有p<0.05）。损伤特征和住院治疗强度与经济毒性没有独立关联。
结论
本研究中的大多数创伤幸存者经历了一定程度的经济毒性，这与所有hrQoL测量中经风险调整后的较差健康结果独立相关。经济毒性的风险因素与损伤严重程度或治疗强度无关，而是与社会人口统计学变量以及院前和院后医疗保健资源利用的测量有关。需要有针对性的干预措施和政策来解决经济毒性问题，并确保创伤幸存者的最佳康复。
证据水平
预后和流行病学；三级。
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