The one year trajectory of elderly patients after cervical spine fracture

老年患者颈椎骨折后一年轨迹

• 批准号: 8519206
• 负责人: Zara R Cooper
• 金额: $ 8.43万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8519206
• 关键词: Accounting; Admission activity; Age; American; Arthrodesis; Caring; Cervical; Cervical spine; Characteristics; Clinical; Comorbidity; Consensus; Data; Elderly; Ethnic Origin; Event; Fracture; Gender; Health; Healthcare; Home environment; Hospitals; Immobilization; Incidence; Injury; Inpatients; Institution; Intervention; Life; Measures; Medicare; Morbidity - disease rate; Nursing Homes; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pattern; Patterns of Care; Phase; Play; Race; Residual state; Resources; Right-On; Role; Series; Services; Site; Skilled Nursing Facilities; Source; Spinal cord injury; Statistical Models; Trauma; Treatment outcome; Variant; Vulnerable Populations; Work; base; beneficiary; cost; falls; functional decline; health care service utilization; high risk; hospital readmission; improved; loss of function; mortality; older patient; patient population; sample fixation; service utilization; trauma care; trauma centers

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.

描述（由申请人提供）：我们建议对种族和护理地点对患有颈椎骨折 (CSFx) 的老年患者一年健康轨迹的影响进行首次全国性检查。这对于老年患者来说是一种潜在的毁灭性损伤，伴有高发病率、死亡率和功能丧失。 CSFx 治疗后一年内老年患者的死亡率超过 20%。 CSFx 对 80 岁以上的患者构成最高风险，他们是美国增长最快的人口。尽管这种常见伤害源具有潜在的负担，但我们对其后果的信息却很少。有关 CSFx 后发病率和死亡率的数据主要限于单一机构系列。此外，对于老年患者的最佳治疗方案，无论是手术关节固定术还是固定术，还是用光环或颈托固定，几乎没有达成共识。由于缺乏数据，一些较小的单一机构研究表明，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，我们缺乏关于全国 CSFx 护理模式的明确数据，以及它们如何因种族、民族、性别和患者居住地区而异。因此，在本研究中，我们将使用国家医疗保险数据来检查患有 CSFx 的老年患者的护理模式。我们将使用统计模型来确定与高死亡率、再入院率、疗养院入院率以及受伤后第一年使用家庭医疗保健相关的患者和医院因素。在这里，我们希望描述全国治疗模式的特征，衡量相关死亡率，定义医疗保健利用的一年轨迹，并研究患者种族和护理地点对该群体的治疗和护理结果的影响。我们希望揭示护理方面的差距，作为制定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、减少护理方面的种族和机构差异，并提高这一弱势群体的医疗保健利用率。