Predictors of Health Care Utilization and Costs Attributable to Hip Fractures

描述(由申请人提供)：髋部骨折是美国老年人发病率和相关医疗费用的主要原因。未来几年，随着人口老龄化带来的一般疾病负担和美国医疗保健系统面临的相关成本压力越来越大，需要努力降低髋部骨折的发病率和成本负担。虽然减少髋部骨折发病率的干预措施取得了一定的成功，但也必须减少治疗和康复髋部骨折的费用，以减轻经济负担。以前对髋部骨折费用的研究仅基于索赔数据，侧重于对特定人群的平均费用的估计，或对影响髋部骨折后急性护理使用的医疗保健系统结构特征的估计，而没有研究可能解释因髋部骨折而产生的巨大个体费用差异的因素。在这项提案中，以及针对国家老龄研究所发布的PA-09-265，我们建议使用一个数据库，将NIH资助的具有里程碑意义的骨折流行病学前瞻性队列研究--骨质疏松性骨折研究(SOF)--与医疗保险索赔数据联系起来。与以前的骨折结果研究最多对非常有限的骨折前特征进行回顾性评估不同，SOF队列对每个研究参与者的骨折前特征进行了全面、多次的测量，并确认了自1992年1月1日以来在10,336名女性中发生的1254例髋部骨折。链接的SOF-Medicare索赔数据集提供了一个独特的机会，可以准确和精确地量化可归因于髋部骨折的医疗成本，并对单个患者骨折前特征和医疗系统结构变量与可归因于髋部骨折的医疗成本和利用率之间的关系提供可靠的估计。我们建议的具体目标是：1)估计骨折前身体表现、积极情绪、抑郁、认知功能和体重与医疗保健费用、急性住院时间、熟练护理机构(SNF)住院时间和髋部骨折患者康复机构(IRF)住院时间的关系；2)估计医疗保健系统结构变量(当地急性护理医院、SNF‘s、IRF’s、家庭保健机构和医疗保健提供者供应的特征)与髋部骨折归因成本和急性医院、SNF和IRF住院时间的关系；以及3)估计髋部骨折的医疗服务利用和费用的长期轨迹。量化可归因于髋部骨折的医疗费用，并确定单个患者骨折前预测因素与独立预测医疗用途和成本的医疗保健系统结构变量之间的关系，将为未来的干预研究和政策规划奠定基础，以修正这些因素，从而降低髋部骨折的总体社会成本负担。

DESCRIPTION (provided by applicant): Hip fractures are a leading cause of morbidity and associated health care costs in older people in the United States. As the general disease burden of the aging population and related cost pressures on the United States health care system mount in the years ahead, efforts are needed to reduce the morbidity and cost burden of hip fractures. While interventions to reduce the incidence of hip fracture have had modest success, costs of treating and rehabilitating hip fractures must also be reduced to lower the economic burden. Previous studies of hip fracture costs have been based on claims data only, have focused on estimation of mean costs across specific populations or on health care system structural characteristics that influence post-acute care use after hip fracture, and have not examined factors that may explain the large individual variation in costs due to hip fracture. In this proposal and in response to PA-09-265 issued by the National Institute on Aging, we propose use a database linking the landmark NIH-funded prospective cohort study of the epidemiology of fractures, the Study of Osteoporotic Fractures (SOF), with Medicare claims data. Unlike previous fracture outcome studies that have at most retrospective assessment of very limited pre-fracture characteristics, the SOF cohort has comprehensive, multiple measurements of pre-fracture characteristics for each study participant and has confirmed 1254 incident hip fractures since January 1, 1992 among 10,336 women. The linked SOF-Medicare claims dataset offers a unique opportunity to quantify with accuracy and precision the health care costs attributable to hip fracture as well as provide robust estimates of the associations of individual patient pre- fracture characteristics and health care system structural variables with health care costs and utilization attributable to hip fracture. The specific aims of our proposal are to: 1) Estimate the associations of pre-fracture trajectories of physical performance, positive affect, depression, cognitive function and body weight with health care costs, acute hospital length of stay, skilled nursing facility (SNF) length of stay, and inpatient rehabilitation facility (IRF) length of stay attributable to hip fracture; 2) Estimate the associations of health care system structural variables (characteristics of local acute care hospitals, SNF's, IRF's, home health care agencies, and health care provider supply) with hip fracture attributable costs and acute hospital, SNF, and IRF lengths of stay after hip fracture; and 3) Estimate the long-term trajectory of health care utilization and costs attributable to hip fracture. Quantification of the health care costs attributable to hip fracture and identification of the associations of individual patient pre-fracture predictors and health care system structural variables that independently predict health care use and costs will lay the foundation for future intervention studies and policy planning to modify these factors such that the overall societal cost burden of hip fractures can be reduced.