Castillo-Angeles Manuel, Zogg Cheryl K, Smith Charlotte B, Etheridge James C, Wu Christine, Jarman Molly P, Nitzschke Stephanie, Askari Reza, Cooper Zara, Salim Ali, Havens Joaquim M
From the Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (M.C.-A., C.B.S., J.C.E., C.W., S.N., R.A., Z.C., A.S., J.M.H.), Brigham and Women's Hospital, Harvard Medical School; Center for Surgery and Public Health, Department of Surgery (M.C.-A., C.K.Z., M.J., Z.C., A.S., J.M.H.), Brigham and Women's Hospital, Harvard Medical School; Harvard T. H. Chan School of Public Health (M.C.-A., C.K.Z., M.J., Z.C., A.S., J.M.H.), Boston, Massachusetts; and Department of Surgery (C.K.Z.), Duke University Medical Center, Durham, North Carolina.
J Trauma Acute Care Surg. 2025 Apr 1;98(4):600-604. doi: 10.1097/TA.0000000000004542. Epub 2024 Dec 20.
Quality benchmarking has recently evolved from a historical focus on short-term morbidity and mortality as the key metrics to assessing long-term outcomes. Long-term quality metrics have been shown to provide a more complete assessment of geriatric trauma care. Among these metrics, patients' average number of healthy days at home (HDAH) proports to be a useful administrative claims-based marker of patient functional status. Our goal was to determine the predictors of HDAH among injured older adults.
Medicare inpatient claims (2014-2015) were used to identify all geriatric trauma patients. Patients' number of HDAH was measured from the date of discharge and calculated as the total sum of patients' time during that period less any time spent in the hospital or emergency department, step-down/rehabilitation/nursing care, home health, or after death within a 365-period after index admission. Controlling for demographic, injury severity, and hospital-level characteristics, multivariable regression analyses were performed to identify the factors associated with increased HDAH.
We included 772,109 geriatric trauma patients. The mean age was 82.15 years (SD, 8.49 years), 68.3% were female, and 91.6% were White. The median HDAH was 351 days (interquartile range, 351-355 days). After adjusted analysis, age, Black race, Charlson Comorbidity Index (CCI), and care at a level 3/nontrauma center were associated with fewer HDAH within 365 days after discharge.
This study suggests that higher level trauma centers provide more HDAH after index admission for injured older adults. Future studies should focus on correlating HDAH with more granular but less readily accessible quality of life metrics.
Prognostic and Epidemiological; Level III.
质量基准评估最近已从以往侧重于将短期发病率和死亡率作为评估长期结果的关键指标，转变为关注长期结果。长期质量指标已被证明能更全面地评估老年创伤护理情况。在这些指标中，患者在家中的平均健康天数（HDAH）似乎是一个基于行政索赔的有用的患者功能状态指标。我们的目标是确定受伤老年人HDAH的预测因素。
利用医疗保险住院索赔数据（2014 - 2015年）识别所有老年创伤患者。患者的HDAH数量从出院日期开始计算，计算方法是该时间段内患者的总时间减去在医院或急诊科、逐步降低护理/康复/护理机构、家庭健康护理机构度过的时间，或在索引入院后365天内死亡后的时间。在控制了人口统计学、损伤严重程度和医院层面特征后，进行多变量回归分析以确定与HDAH增加相关的因素。
我们纳入了772,109名老年创伤患者。平均年龄为82.15岁（标准差8.49岁），68.3%为女性，91.6%为白人。HDAH的中位数为351天（四分位间距，351 - 355天）。经过调整分析，年龄、黑人种族、Charlson合并症指数（CCI）以及在三级/非创伤中心接受护理与出院后365天内较少的HDAH相关。
本研究表明，对于受伤的老年人，较高水平的创伤中心在索引入院后能提供更多的HDAH。未来的研究应侧重于将HDAH与更细化但获取难度更大的数据的生活质量指标相关联。
预后和流行病学；三级。
