The cost of preventable conditions in adults with spina bifida
The cost of preventable conditions in adults with spina bifida
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DOI：
10.1055/s-2008-1071031
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发表时间：
1996-12-01
影响因子：
1.8
通讯作者：
Doehring, MC
中科院分区：
文献类型：
--
作者：
Kinsman, SL;Doehring, MC
患有脊柱裂的成年人有患继发性健康状况的风险，这些健康状况与原发性疾病有因果关系，并且在某种程度上是可以预防的。通过调查成人脊柱裂可预防的继发性疾病，我们可以确定如果制定预防策略，可能会减轻护理负担。我们审核了患有脊柱裂的成人的住院情况，以深入了解该人群中严重的继发性疾病。我们回顾了 11 年来收治美国一家大型三级护理中心（约翰·霍普金斯医院；马里兰州巴尔的摩）的所有成人脊柱裂患者。我们确定了每次入院的出院诊断以及与入院相关的医院费用。我们定义了该成年人口中可预防的继发性疾病，并计算了这些继发性疾病占总入院人数和总费用的百分比。患者群体为1982年1月至1992年12月收治的18岁及以上脊柱裂患者，其中女性59例，男性39例。我们的 77 名患者被确定为白人，20 名黑人，1 名“其他”患者。患者年龄从 18 岁到 61 岁不等，平均年龄为 25.8 岁。两年期间，共有 353 名患者入院，每名患者入院人数从 1 人到 25 人不等。每名患者平均入院人数为 3.6 人，所有入院患者的平均住院时间为 11.2 天。在 353 例入院病例中，166 例 (47.0%) 是由于可能可预防的继发性疾病，如严重泌尿系统感染、肾结石、压疮和骨髓炎。由于这些次要条件远入院，平均住院时间为12.5天。 1990 年、1991 年和 1992 年的医院总费用（不包括专业费用）分别为 175,885 美元、247,355 美元和 437,262 美元。本研究中未调查的继发性病症导致的永久性功能丧失也可能是患者长期经济和心理成本的一个来源。这项研究发现大量患者多次入院，并且许多入院符合潜在可预防的条件。如果我们要了解与脊柱裂成人继发性健康状况相关的因素，则需要更多信息。我们需要调查医生和患者的知识、态度和行为对患者治疗结果的影响。
Adults with spina bifida are at risk of developing secondary health conditions that are causally related to the primary condition and are to some degree preventable. By investigating preventable secondary conditions in adults with spina bifida, we can determine the burden of care that might be reduced if preventive strategies were developed. We audited hospitalizations of adults with spina bifida to gain insight into serious secondary conditions in this population. We reviewed all admissions of adults with spina bifida to a large American tertiary care center (Johns Hopkins Hospital; Baltimore, Maryland) over 11 years. We determined the discharge diagnoses for each admission and the hospital costs associated with admission. We defined preventable secondary conditions in this adult population and calculated the percentage of total admissions and of total costs for these secondary conditions. The patient population consisted of spina bifida patients 18 years and over admitted from January 1982 to December 1992, including 59 females and 39 males. 77 of our patients were identified as white, 20 as black, and 1 as ''other'' Patient age ranged from 18 to 61 years with an average age of 25.8 years. There were 353 admissions and admissions per patient ranged from 1 to 25 over the Ii-year period. The average number of admissions per patient was 3.6 and the average length of stay for all admissions was 11.2 days. Of the 353 total admissions, 166 (47.0%) were due to potentially preventable secondary conditions such as serious urologic infections, renal calculi, pressure ulcers, and osteomyelitis. Far admissions due to these secondary conditions, the average length of stay was 12.5 days. The total hospital costs, excluding professional fees, were $175,885, $247,355, and $437,262 for 1990, 1991, and 1992 respectively. Permanent loss of function resulting from secondary conditions, not investigated in this study, can also be a source of long-term financial and psychological cost to the patient. This study found a high number of patients with multiple admissions and that many admissions quali fied as potentially preventable. More information is needed If we are to understand the factors associated with secondary health conditions in adults with spina bifida. We need to investigate the roles played by physician and patient knowledge, attitudes, and behaviors in contributing to patient outcome.