The one year trajectory of elderly patients after cervical spine fracture

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DESCRIPTION (provided by applicant): We propose the first national examination of the effect of race and site of care on the one-year health trajectory for elderly patients sustaining cervical spine fracture (CSFx). This is a potentially devastating injury for elderly patients associated with high rates of morbidity, mortality, and loss of function. Mortality in elderly patients during the year following CSFx exceeds 20%. CSFx poses the highest risk to patients over 80, who are the nation's fastest growing demographic. Despite the potential burden of this common source of injury, we have little information about its outcomes. Data about morbidity and mortality after CSFx is largely limited to single-institution series. Furthermore, there is litle consensus as to the best course of treatment for elderly patients, either surgical arthrodesis or fixation, or immobilization with a halo or cervical collar. Because of a lack of data, some smaller single-institution studies suggest that factors such as race, gender, and site of care seem to influence treatment decisions and clinical outcomes in ways that are likely not clinically appropriate. However, we lack clear data on the national patterns of care for CSFx, and how they vary by race and ethnicity, gender, and the region where patients live. Therefore, in this study, we will use national Medicare data to examine patterns of care for elderly patients who suffer CSFx. We will use statistical models to identify patient and hospital factors associated with high rates of mortality, hospital readmission, nursing home admission and the use of home healthcare in the first year after injury. Here, we hope to characterize national treatment patterns, measure associated mortality, define the one-year trajectory of healthcare utilization, and examine the influence of patient race and site of care on treatment and outcomes of care for this group. We expect to reveal gaps in care as potential targets for developing meaningful interventions to reduce mortality, mitigate functional decline, reduce racial and institutional disparities in care, and improve healthcare utilization for this vulnerable population. PUBLIC HEALTH RELEVANCE: We propose the first national examination of the effect of race and site of care on the one-year health trajectory for elderly patients sustaining cervical spine fracture. We will identify gaps in care as targets to improve treatment, reduce mortality, and mitigate functional decline in this group.