Direct cost associated with acquired brain injury in Ontario.
Direct cost associated with acquired brain injury in Ontario.
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DOI：
10.1186/1471-2377-12-76
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发表时间：
2012-08-17
期刊：
影响因子：
2.6
通讯作者：
Wodchis WP
中科院分区：
文献类型：
--
作者：
Chen A;Bushmeneva K;Zagorski B;Colantonio A;Parsons D;Wodchis WP
创伤性和非创伤性获得性脑损伤（ABI）是世界范围内致残的主要原因，但总结与ABI相关的卫生系统经济负担的研究有限。本研究的目的是确定加拿大安大略省创伤性（TBI）和非创伤性脑损伤（nTBI）患者从最初住院到受伤后三年的公共资助医疗保健服务的直接成本。从管理数据中确定了2004年至2007年安大略省任何诊断位置具有ABI代码的急性医院出院患者的基于人群的队列。从安大略省的几个行政保健数据库中获得了公共资助的保健利用情况。根据脑损伤的创伤性和非创伤性原因以及是否出院到住院康复中心对患者进行分层。在初次出院后长达三年的时间里，在连续的机构和社区环境中计算卫生系统成本。连续设置包括急诊科住院康复（IR）复杂的持续护理家庭护理服务和医生就诊。所有成本都是以政府付款人的角度追溯计算的。ABI人群的直接医疗费用相当可观，每位TBI和nTBI患者受伤后第一年的平均费用分别为32132美元和38018美元。在所有机构和社区环境中，在TBI和nTBI患者中，出院接受IR治疗的患者的治疗费用明显高于未出院接受IR治疗的患者。这一趋势在整个三年随访期间保持不变。安大略省脑损伤住院患者在第一个随访年度的医疗费用约为创伤性脑损伤1.207亿美元，非创伤性脑损伤3.687亿美元。第一年急症护理费用占总治疗费用的46-65%，压倒了所有其他费用组成部分。本研究的主要发现是ABI人群的直接医疗费用很大，并且因伤害原因而有很大差异。虽然大多数费用发生在第一个随访年，但ABI患者在第二年和第三年继续使用各种医疗服务，随着时间的推移，重点从急性护理和住院康复转向家庭护理医生服务和长期机构护理。需要更多的研究来捕捉未接受急性护理的ABI患者的经济成本。
Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada. A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer’s perspective. Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components. The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
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影响因子：
5.1
作者：
Andlin-Sobocki, P;Jönsson, B;Olesen, J
通讯作者：
Olesen, J
影响因子：
4.3
作者：
Greenwald, BA;Burnett, DM;Miller, MA
通讯作者：
Miller, MA
影响因子：
2.4
作者：
Brener, I;Harman, JS;Yeates, KO
通讯作者：
Yeates, KO
影响因子：
168.9
作者：
Ghajar, J
通讯作者：
Ghajar, J
影响因子：
2.6
作者：
Mar J;Arrospide A;Begiristain JM;Larrañaga I;Elosegui E;Oliva-Moreno J
通讯作者：
Oliva-Moreno J