Campbell A R, Vittinghoff E, Morabito D, Paine M, Shagoury C, Praetz P, Grey D, McAninch J W, Schecter W P
Department of Surgery, University of California, San Francisco, USA.
J Trauma. 1995 Aug;39(2):246-51; discussion 251-3. doi: 10.1097/00005373-199508000-00010.
Health care reform will affect the relationship of trauma centers to health maintenance organizations and other managed care plans. We studied Kaiser Permanente Medical Center (Kaiser) members admitted to the Trauma Center at San Francisco General Hospital (SFGH) to determine: (1) variables predicting transfer from SFGH to a Kaiser Hospital (repatriation), (2) the length of hospital stay (LOS), and (3) the cost of their care. The SFGH trauma registry provided data on 7,794 patients admitted before 1994. To investigate LOS, 89 Kaiser patients over 1 year were matched with non-Kaiser patients on age, maximum Abbreviated Injury Scale score (MAIS) by body region, Injury Severity Score (ISS), head injury severity, and blunt or penetrating injury and disposition. Kaiser patients were significantly younger, more likely to have blunt injury, and had a lower death rate. Significant predictors of repatriation were an MAIS score > or = 3, abdominal or extremity injury, and an ISS score of 26 to 40. The mean LOS for all Kaiser patients was 7.6 days, compared with 4.8 for controls (p = 0.20). However, mean LOS was significantly longer in repatriated Kaiser patients compared with controls (16 vs. 7.8 days, p < 0.0005). Kaiser reimbursement rates were comparable with commercial payors, but higher than others. A relatively small number of severely injured patients account for a large percentage of costly trauma care. Analyses of patient subsets are necessary for trauma centers to negotiate suitable relationships with managed care plans. A prospective study is needed to examine the cost efficiency of early transfer of managed care patients.
医疗保健改革将影响创伤中心与健康维护组织及其他管理式医疗计划之间的关系。我们研究了入住旧金山综合医院（SFGH）创伤中心的凯撒永久医疗中心（Kaiser）成员，以确定：（1）预测从SFGH转至凯撒医院（遣返）的变量，（2）住院时间（LOS），以及（3）其护理费用。SFGH创伤登记处提供了1994年之前入院的7794名患者的数据。为研究LOS，将89名1岁以上的凯撒患者与非凯撒患者在年龄、按身体部位划分的最高简明损伤定级标准评分（MAIS）、损伤严重度评分（ISS）、头部损伤严重程度以及钝性或穿透性损伤及处置情况方面进行匹配。凯撒患者明显更年轻，更有可能遭受钝性损伤，且死亡率更低。遣返的显著预测因素为MAIS评分≥3、腹部或四肢损伤以及ISS评分为26至40。所有凯撒患者的平均LOS为7.6天，而对照组为4.8天（p = 0.20）。然而，与对照组相比，遣返的凯撒患者的平均LOS显著更长（16天对7.8天，p < 0.0005）。凯撒的报销率与商业支付方相当，但高于其他支付方。相对少数的重伤患者占创伤护理高昂费用的很大比例。创伤中心需要对患者亚组进行分析，以便与管理式医疗计划协商合适的关系。需要进行一项前瞻性研究来考察管理式医疗患者早期转移的成本效益。
