Developing a measure of overall intensity of injury care: A latent class analysis.
Developing a measure of overall intensity of injury care: A latent class analysis.
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DOI：
10.1097/ta.0000000000003321
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发表时间：
2022-01-01
期刊：
影响因子：
--
通讯作者：
Carr BG
中科院分区：
文献类型：
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作者：
Zebrowski AM;Hsu JY;Holena DN;Wiebe DJ;Carr BG
虽然伤害是老年人死亡和虚弱的主要原因，但护理强度与创伤之间的关系仍然未知。该分析的重点是衡量住院期间受伤老年人的整体护理强度。我们使用医疗保险和医疗补助服务中心的医疗保险按服务收费索赔数据（2013-2014 年）来确定符合年龄资格的受益人中度和重度钝性创伤的基于 ED 的索赔。使用改进的德尔菲法确定了与护理强度相关的医疗程序。使用已确定的程序、ICU 住院时间、人口统计数据和损伤特征来估计潜在类别模型。探索了每个类别的临床表型。共有 683,398 例病例被分为低强度（73%）、中度（23%）和高强度护理（4%）。年龄较大和损伤严重程度降低是强度较低的指标，而男性、非白人和非跌倒机制在高强度下更常见。插管/机械通气是高强度的一个指标，通常与至少一项其他手术或延长 ICU 住院时间同时发生。这项工作表明，尽管钝性创伤的护理存在异质性，但可以使用单一的新颖措施进行评估。 III 级预后/流行病学研究
While injury is a leading cause of death and debility in older adults, the relationship between intensity of care and trauma remains unknown. The focus of this analysis is to measure the overall intensity of care delivered to injured older adults during hospitalization. We used Centers for Medicare and Medicaid Services Medicare fee-for-service claims data (2013–2014), to identify ED-based claims for moderate and severe blunt trauma in age-eligible beneficiaries. Medical procedures associated with care intensity were identified using a modified Delphi method. A latent class model was estimated using the identified procedures, ICU length of stay, demographics, and injury characteristics. Clinical phenotypes for each class were explored. A total of 683,398 cases were classified as low intensity (73%), moderate (23%), and high intensity care (4%). Greater age and reduced injury severity were indicators of lower intensity, while males, non-whites, and non-fall mechanisms were more common with high intensity. Intubation/mechanical ventilation was an indicator of high intensity and often occurred with at least one other procedure or an extended ICU stay. This work demonstrates that although heterogeneous, care for blunt trauma can be evaluated using a single novel measure. Level III for Prognostic/Epidemiological Studies