'Costs & Effectiveness of Trauma Care in the Elderly'

描述(申请人提供)：每年有近百万名老年人 因急性创伤住院治疗，这些数字是 预计随着老年人口比例的增加而增加 他们跌倒、机动车撞车和袭击的风险增加了，因为 改善整体健康状况和机动性。创伤的转归 老年人往往是穷人，因为他们是级联事件中的早期事件 行动不便、丧失工作能力和死亡。虽然系统的方法来交付 创伤护理(将较严重的伤者分流到指定的三级医院 护理机构或创伤中心)被广泛倡导用于改善这些 结果，有大量证据表明，一半到三分之二 有严重创伤的老年人目前没有在外伤科接受治疗 中心，这一比例远远高于年轻患者。可用数据， 然而，不允许我们确定创伤的结果是否真的更好 中心与非创伤中心。可用于比较的数据甚至更少 在创伤中心和非创伤中心医院接受治疗的费用。 拟议研究的目的有三个：(1)估算成本 与老年创伤的急诊护理和急诊后护理相关 比较在创伤中心治疗的患者和在创伤中心接受治疗的患者的这些费用 非创伤中心；(2)检查现有医疗服务的贡献 老年人创伤后的费用和结果状况并进行检查 既往老年人创伤中心/非创伤中心的差异 条件；以及(3)描述成本和结果之间的关系 在创伤中心和非创伤中心接受护理，并检查 这些关系对政策和方案倡议的影响。这个 研究利用现有的努力收集一年的时间 3000多名老年创伤患者在创伤中心和医院接受治疗的结果 非创伤中心。目前的要求是为医疗保险的分析提供资金 索赔数据。这一分析将极大地提高我们估计 与伤害有关的急性护理和急性后护理费用以及 提供有关受伤前发病率的更好信息，已知 对结果和成本都有很大影响。

DESCRIPTION (provided by applicant): Each year, nearly one million elders are hospitalized for treatment of an acute traumatic injury, and these figures are expected to increase as the proportion of the population that is older grows and their risk of falls, motor vehicle crashes and assaults increases due to improved overall health status and mobility. The outcome from trauma in the elderly is often poor as it serves as the incipient event in a cascade leading to immobility, incapacity and death. While a systems approach to the delivery of trauma care (with triage of the more acutely injured to designated tertiary care facilities or trauma centers) is widely advocated for improving these outcomes, there is substantial evidence to suggest that one half to two thirds of older adults with major trauma are not currently being treated at trauma centers, a far higher proportion than in younger patients. Available data, however, do not allow us to determine if outcomes are indeed better in trauma centers versus non-trauma centers. Even fewer data are available for comparing the costs of care received in trauma centers and non-trauma center hospitals. The aims of the proposed study are three-fold: (1) to estimate the costs associated with the acute care and post-acute care of the elderly trauma patient and to compare these costs for patients treated at trauma centers and non-trauma centers; (2) to examine the contribution of pre-existing medical conditions on costs and outcomes following trauma in the elderly and to examine trauma center/non-trauma center differences among the elderly with pre-existing conditions; and (3) to describe the relationship between costs and outcomes of care received in trauma centers and non-trauma centers and examine the implications of these relationships for policy and program initiatives. The study takes advantage of an existing effort that is collecting one-year outcomes on over 3,000 elderly trauma patients treated at trauma centers and non-trauma centers. The current request is for funding an analysis of Medicare claims data. This analysis would substantially improve our ability to estimate costs of both acute and post-acute care related to the injury as well as provide better information on pre-injury morbidity which is known to substantially affect both outcomes and cost.