The one year trajectory of elderly patients after cervical spine fracture

描述（由申请人提供）：我们建议进行第一次全国范围的种族和护理地点对老年颈椎骨折患者一年健康轨迹的影响的研究（CSFx）。对于老年患者来说，这是一种潜在的破坏性损伤，具有高发病率、死亡率和功能丧失。在CSFx之后的一年中，老年患者的死亡率超过20%。CSFx对80岁以上的患者风险最高，而80岁以上的患者是美国增长最快的人群。尽管这种常见的损伤来源可能带来潜在的负担，但我们对其结果知之甚少。CSFx术后发病率和死亡率的数据主要局限于单机构系列。此外，对于老年患者的最佳治疗方案，无论是手术关节融合术或固定，还是用晕或颈套固定，目前还没有达成共识。由于缺乏数据，一些较小的单机构研究表明，种族、性别和护理地点等因素似乎以可能不适合临床的方式影响治疗决策和临床结果。然而，我们缺乏关于CSFx国家护理模式的明确数据，以及它们如何因种族和民族、性别和患者居住地区而变化。因此，在本研究中，我们将使用国家医疗保险数据来检查老年CSFx患者的护理模式。我们将使用统计模型来确定与高死亡率、再入院率、养老院入院率和受伤后第一年家庭保健使用相关的患者和医院因素。在这里，我们希望描述国家治疗模式，测量相关死亡率，定义医疗保健利用的一年轨迹，并检查患者种族和护理地点对该组治疗和护理结果的影响。我们希望揭示护理差距，作为开发有意义的干预措施的潜在目标，以降低死亡率，减轻功能衰退，减少护理中的种族和制度差异，并提高弱势群体的医疗保健利用率。

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.