Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults
Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults
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DOI：
10.1097/mlr.0000000000000531
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发表时间：
2016-07-01
期刊：
影响因子：
3
通讯作者：
Ettner, Susan L.
中科院分区：
文献类型：
--
作者：
Hoffman, Geoffrey J.;Hays, Ron D.;Ettner, Susan L.
目的：使用几种方法比较跌倒相关伤害（FRI）的支出，以识别行政索赔数据中的FRI。研究设计：使用2007-2009年的医疗保险索赔和2008年的健康和退休调查数据，FRI是使用外部伤害原因确定的。（电子代码880/881/882/884/885/888），电子代码加上一组广泛的主要诊断代码，以及使用电子代码和诊断和程序代码的更新方法。根据社会人口统计学、健康和地理特征调整的线性回归模型用于估计每FRI、服务组成、患者成本份额、初始FRI治疗类型的支出（住院、仅急诊、门诊）和年度FRI相关医疗保险支出总额。该分析包括5497名社区居住的成年人Z65（228 FRI，5269 non-FRI individuals）与连续的医疗保险覆盖面和生活在24个月的研究。3种FRI识别方法产生了不同的指数FRI类型分布和不同的估计支出：12，171美元[ 95%置信区间（CI），4662 - 19，680美元]、5648美元（95% CI，3819- 7476美元）和9388美元（95% CI，5969- 12，808美元）。在所有模型中，大多数支出发生在医院，门诊，和熟练的护理设施（SNF）的设置，但更大比例的SNF和门诊支出观察到常用的FRI识别方法。3种方法的患者费用分摊估计为691 - 1900美元。在所有方法中，住院患者治疗的指数FRI比急诊科和门诊患者治疗的FRI更昂贵，但仅使用电子代码识别FRI时要高得多。估计总FRI相关的医疗支出是高度可变的跨methods.Conclusions：FRI是昂贵的，与医疗保险及其受益人的影响。然而，根据确定森林资源机构所用的方法，支出估计数差异很大。
Objectives: Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.Research Design: Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.Subjects: The analysis included 5497 community-dwelling adults Z65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.Results: The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [ 95% confidence interval (CI), $4662-$19,680], $ 5648 (95% CI, $ 3819-$ 7476), and $ 9388 (95% CI, $ 5969-$ 12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.Conclusions: FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.