The Short and the Long of it: Timing of Mortality for Older Adults in a State Trauma System.
The Short and the Long of it: Timing of Mortality for Older Adults in a State Trauma System.
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DOI：
10.1016/j.jss.2021.06.042
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Carr BG
中科院分区：
文献类型：
--
作者：
Kaufman EJ;Zebrowski AM;Holena DN;Loher P;Wiebe DJ;Carr BG
损伤的影响超出了住院时间，但创伤中心的绩效指标通常集中在住院死亡率上。我们比较了宾夕法尼亚州创伤中心的住院和长期死亡率的风险调整率。我们假设院内死亡率低的中心也会有较低的长期死亡率。我们使用宾夕法尼亚州创伤结局研究（Pennsylvania trauma Outcomes Study，一个健全的、全州范围的创伤登记系统）确定了2013年和2014年在宾夕法尼亚州创伤中心住院的受伤患者（年龄≥65岁）。我们将创伤登记记录与2013-2015年的医疗保险索赔进行了匹配。匹配变量包括入院日期和患者人口统计数据，包括出生日期、邮政编码、性别和种族/民族。检查的结果包括住院死亡率、30天死亡率和1年死亡率。建立多变量logistic回归模型，包括表现生理学、合并症、损伤特征和人口统计学，以计算每个创伤中心在每个时间点的预期死亡率。创伤中心的表现采用观察到的预期比率和住院死亡率、30天死亡率和1年死亡率排名进行评估。在28个中心接受治疗的15,451名患者中，8.1%在出院前死亡或出院到临终关怀。另有3.4%的人在30天内死亡，另有14.7%的人在受伤一年内死亡。在住院幸存但在30天内死亡的患者中，92.5%因跌倒受伤，75.0%持续头部损伤。出院在家的患者一年生存率（88.4%）高于出院到专业护理机构或长期急性护理医院的患者（分别为72.7%和52.6%）。三个中心被确定为院内死亡率的异常值（两个低，一个高），当视界延伸到受伤后30天时，没有一个是异常值。在30天，发现了两个不同的低异常值和两个不同的高异常值。近三分之一在受伤后30天内死亡的受伤老年人在出院后死亡。住院死亡率的医院排名与长期预后相关性很差。这些发现强调了从生存到出院对质量改进和基准的重要性。
The impact of injury extends beyond the hospital stay, but trauma center performance metrics typically focus on in-hospital mortality. We compared risk adjusted rates of in-hospital and long-term mortality among Pennsylvania trauma centers. We hypothesized that centers with low rates of in-hospital mortality would also have low rates of long-term mortality. We identified injured patients (age ≥ 65) admitted to Pennsylvania trauma centers in 2013 and 2014 using the Pennsylvania Trauma Outcomes Study, a robust, state-wide trauma registry. We matched trauma registry records to Medicare claims from the years 2013–2015. Matching variables included admission date and patient demographics including date of birth, zip, sex, and race/ethnicity. Outcomes examined were inpatient, 30-day, and 1-year mortality. Multivariable logistic regression models including presenting physiology, comorbidities, injury characteristics, and demographics were developed to calculate expected mortality rates for each trauma center at each time point. Trauma center performance was assessed using observed-to-expected ratios and ranking for in-hospital, 30-day, and 1-year mortality. Of the 15,451 patients treated at 28 centers, 8.1% died before discharge or were discharged to hospice. Another 3.4% died within 30 days, and another 14.7% died within one year of injury. Of patients who survived hospitalization but died within 30 days, 92.5% were injured due to fall, and 75.0% sustained head injuries. Survival at one year was higher in patients discharged home (88.4%), compared to those discharged to a skilled nursing facility or long-term acute care hospital (72.7% and 52.6%, respectively). Three centers were identified as outliers (two low and one high) for in-hospital mortality, none of which were outliers when the horizon was stretched to 30 days from injury. At 30 days, two different low and two different high outliers were found. Nearly one-in-three injured older adults who die within 30 days of injury dies after hospital discharge. Hospital rankings for in-hospital mortality correlate poorly with long-term outcomes. These findings underscore the importance of looking beyond survival to discharge for quality improvement and benchmarking.
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DOI：
10.1016/j.jamcollsurg.2009.07.001
发表时间：
2009-10-01
影响因子：
5.2
作者：
Shafi, Shahid;Nathens, Avery B.;Fildes, John J.
通讯作者：
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影响因子：
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影响因子：
16.9
作者：
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DOI：
10.1186/1757-7241-16-7
发表时间：
2008-08-01
影响因子：
3.3
作者：
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Lossius, Hans Morten