Health Care Expenditures Associated With Skeletal Fractures Among Medicare Beneficiaries, 1999-2005
Health Care Expenditures Associated With Skeletal Fractures Among Medicare Beneficiaries, 1999-2005
复制标题
DOI：
10.1359/jbmr.090523
复制
发表时间：
2009-12-01
影响因子：
6.2
通讯作者：
Delzell, Elizabeth
中科院分区：
文献类型：
--
作者：
Kilgore, Meredith L.;Morrisey, Michael A.;Delzell, Elizabeth
骨折给个人和医疗保健系统带来了巨大的成本和健康负担。对于年长的美国人和医疗保险制度来说，情况尤其如此。这项研究的目的是估计在医疗保险受益人中与选定骨折相关的护理成本。这是一项使用管理数据的回溯性、个人层面的骨折前/骨折后分析。这项研究使用了1999年至2005年的联邦医疗保险申领数据，样本为5%的联邦医疗保险受益人。研究对象包括65岁的联邦医疗保险受益人，他们在A部分和B部分都有至少13个月的保险，没有参加联邦医疗保险优势计划，并在2000年至2005年期间经历了髋部、股骨、骨盆、胫骨/腓骨、脚踝、前臂远端、非远端桡骨/尺骨、肱骨、锁骨、脊柱或手腕的闭合性骨折，或前臂远端或脚踝的任何骨折。主要的结果衡量标准是骨折事故后前6个月的医疗保险覆盖服务的增量(大于基线)和可归因性(直接相关)付款。增加的赔偿金额从前臂远端骨折的7788美元(95%CI，7550-8025美元)到开放性髋部骨折的31,310美元(95%CI，31,073-31,547美元)；前臂远端骨折和髋部骨折的可归因性赔偿分别为1856美元和18,734美元。骨折与医疗保险受益人的医疗服务利用率和费用的大幅增加有关，但这些费用中的很大比例并不直接归因于骨折治疗。还需要进一步的研究来确定其他健康状况，这些健康状况正在推动骨折后医疗保险受益人的成本。《矿工杂志》2009；24：2050-2055。2009年5月18日在线发布；DOI：10.1359/JBMR.090523
Fractures impose substantial burdens, in terms of both costs and health, on individuals and health care systems. This is particularly true for older Americans and the Medicare system. The objective of this study was to estimate the costs of care associated with selected fractures among Medicare beneficiaries. This was a retrospective, person-level, pre/postfracture analysis using administrative data. The study used Medicare claims data from 1999 through 2005 for a 5% sample of Medicare beneficiaries. The subjects included Medicare beneficiaries, >= 65 yr of age, who had at least 13 mo of both Parts A and B coverage and not enrolled in Medicare Advantage and who experienced a closed fracture of the hip, femur, pelvis, tibia/fibula, ankle, distal forearm, nondistal radius/ulna, humerus, clavicle, spine, or wrist, or any fracture of the distal forearm or ankle during the years 2000 through 2005. The main outcome measures were incremental (greater than baseline) and attributable (directly associated) payments for Medicare-covered services for the first 6 mo after incident fractures. Incremental payments ranged from $7788 (95% CI, $7550-$8025) for distal forearm fractures to $31,310 (95% CI, $31,073-$31,547) for open hip fractures; the attributable payments for distal forearm and hip fractures were $1856 and $18,734, respectively. Fractures are associated with substantial increases in health services utilization and costs among Medicare beneficiaries, but significant proportions of those costs are not directly attributable to fracture treatment. Further research is needed to ascertain other health conditions that are driving costs for Medicare beneficiaries after fractures. J Bone Miner Res 2009;24:2050-2055. Published online on May 18, 2009; doi: 10.1359/JBMR.090523