A population-based sex-stratified study to understand how health status preceding traumatic brain injury affects direct medical cost.
A population-based sex-stratified study to understand how health status preceding traumatic brain injury affects direct medical cost.
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一项基于人群的性别分层研究，旨在了解创伤性脑损伤之前的健康状况如何影响直接医疗费用。
DOI：
10.1371/journal.pone.0240208
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Escobar MD
中科院分区：
文献类型：
--
作者：
Chan V;Hurst M;Petersen T;Liu J;Mollayeva T;Colantonio A;Sutton M;Escobar MD
了解创伤性脑损伤（TBI）前5年的健康状况如何影响伤后2年的直接医疗费用。从基于人群的卫生管理数据中确定了2007年4月1日至2014年3月31日期间在加拿大安大略急诊科（艾德）或TBI急性护理中年龄≥19岁的患者（N = 55，669）。受伤前健康状况的43个因素（即，合并症和个人，社会和环境因素），这些因素在TBI人群中进行了内部验证。关注的结果是出院后两年内的直接医疗费用。进行性别特异性多变量线性回归，以了解出院后两年内的直接医疗费用与受伤前健康状况之间的关系。在艾德接受治疗的患者（总样本的81.9%）在受伤后两年内的平均费用为2，492美元/男性患者（平均12，342美元/患者）和3，508美元/女性患者（平均65，285美元/患者）; 37个受伤前因素与直接医疗费用增加显著相关。在急性护理中首次接受TBI护理的患者（18.1%）在受伤后两年内的平均费用为25，081美元/男性患者（平均63，060美元/患者）和30，277美元/女性患者（平均65，285美元/患者）; 21个因素与直接医疗费用增加显著相关。在较普遍的因素中，与医疗费用增加至少50%相关的因素包括精神健康障碍、药物滥用、老年人常见的疾病或医疗状况、心血管疾病、中风和涉及大脑的紧急情况、代谢障碍和腹部症状、腹部和骨盆的状况和症状、泌尿生殖系统疾病和前列腺疾病，肺、腹部等急症。TBI后两年的直接医疗费用在有和没有不良预先存在的健康状况的患者之间存在显着差异。跨学科团队，以促进早期识别预先存在的健康状况和适当的管理和整合这些条件在TBI护理在整个医疗保健的连续性可能是机会，以减少直接的医疗费用受伤后。
To understand how pre-injury health status present five-years preceding traumatic brain injury (TBI) affects direct medical cost two years post-injury. Patients age ≥19 years in the emergency department (ED) or acute care for a TBI between April 1, 2007 and March 31, 2014 in Ontario, Canada (N = 55,669) were identified from population-based health administrative data. Forty-three factors of pre-injury health status (i.e., comorbidities and personal, social, and environmental factors) that were internally validated for the TBI population were assessed in this study. The outcome of interest was direct medical cost within two years of discharge. Sex-specific multivariable linear regressions were conducted to understand the associations between direct medical cost within two years of discharge and pre-injury health status. Patients who received care in the ED (81.9% of total sample) incurred a median cost of $2,492/male patient (average $12,342/patient) and $3,508/female patient (average $65,285/patient) within two years of injury; 37 pre-injury factors were significantly associated with increased direct medical costs. Patients who first received care for their TBI in acute care (18.1%) incurred a median cost of $25,081/male patient (average $63,060/patient) and $30,277/female patient (average $65,285/patient) within two years of injury; 21 factors were significantly associated with increased direct medical costs. Among more prevalent factors, those associated with increased medical cost by at least 50% included mental health disorders, substance abuse, disorders or medical conditions frequently observed among the elderly, cardiovascular disorders, stroke and emergencies involving the brain, metabolic disorders and abdominal symptoms, conditions and symptoms of abdomen and pelvis, genitourinary disorders and disorders of prostate, and pulmonary abdominal and other emergencies. Direct medical costs two years post-TBI differed significantly between patients with and without adverse pre-existing health status. Interdisciplinary teams to promote early identification of pre-existing health conditions and appropriate management and integration of these conditions in TBI care across the continuum of healthcare may be opportunities to reduce direct medical costs post-injury.
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影响因子：
2.6
作者：
Chen A;Bushmeneva K;Zagorski B;Colantonio A;Parsons D;Wodchis WP
通讯作者：
Wodchis WP
DOI：
10.1080/09540121.2017.1344350
发表时间：
2018-01-01
影响因子：
1.7
作者：
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通讯作者：
Perel, Pablo
影响因子：
1.9
作者：
Marin JR;Weaver MD;Mannix RC
通讯作者：
Mannix RC
影响因子：
3.3
作者：
Damian AJ;Gallo JJ;Mendelson T
通讯作者：
Mendelson T
影响因子：
2.6
作者：
Chan V;Thurairajah P;Colantonio A
通讯作者：
Colantonio A