Seung Hoon Kim, Suk-Yong Jang, Yonghan Cha, Hajun Jang, Bo-Yeon Kim, Hyo-Jung Lee, Gui-Ok Kim
{"title":"医院数量和地区对髋部骨折后老年患者死亡率、医疗费用和住院时间的影响：一项全国索赔数据库分析","authors":"Seung Hoon Kim, Suk-Yong Jang, Yonghan Cha, Hajun Jang, Bo-Yeon Kim, Hyo-Jung Lee, Gui-Ok Kim","doi":"10.4055/cios24193","DOIUrl":null,"url":null,"abstract":"<p><strong>Backgroud: </strong>The purpose of our study was to analyze the effects of hospital volume and region on in-hospital and long-term mortality, direct medical costs (DMCs), and length of hospital stay (LOS) in elderly patients following hip fracture, utilizing nationwide claims data.</p><p><strong>Methods: </strong>This retrospective nationwide study sourced its subjects from the Korean National Health Insurance Review and Assessment Service database spanning from January 2011 to December 2018. A generalized estimating equation model with a Poisson distribution and logarithmic link function was used to estimate adjusted odds ratios (aORs) and 95% CIs to assess the association of hospital volume with in-hospital and 1-year mortality, DMCs, and LOS.</p><p><strong>Results: </strong>A total of 172,144 patients were included. Comparing the risk of in-hospital death between high-volume and low-volume hospitals, the risk of in-hospital death was 1.2 times higher at low-volume hospitals (aOR, 1.20; 95% CI, 1.07-1.33; <i>p</i> = 0.002). Additionally, the risk of death at 1 year was 1.05 times higher at low-volume hospitals (aOR, 1.05; 95% CI, 1.01-1.09; <i>p</i> = 0.008) compared to high-volume hospitals. DMCs were 0.84 times lower at low-volume hospitals for in-hospital period (aOR, 0.84; 95% CI, 0.84-0.85; <i>p</i> < 0.001) and 0.87 times lower for 1 year (aOR, 0.87; 95% CI, 0.86-0.88; <i>p</i> < 0.001) compared to high-volume hospitals. In-hospital LOS was 1.21 times longer at low-volume hospitals (aOR, 1.21; 95% CI, 1.20-1.22; <i>p</i> < 0.001) than at high-volume hospitals. In addition, the risk of in-hospital death was 1.22 times higher (aOR, 1.22; 95% CI, 1.12-1.33; <i>p</i> < 0.001) and the risk of 1-year death was 1.07 times higher (aOR, 1.07; 95% CI, 1.04-1.10; <i>p</i> < 0.001) at rural hospitals compared to urban hospitals.</p><p><strong>Conclusions: </strong>Clinicians should focus on improving clinical outcomes for hip fracture patients in low-volume and rural hospital settings, with a specific emphasis on reducing mortality rates.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"80-90"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791489/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Impact of Hospital Volume and Region on Mortality, Medical Costs, and Length of Hospital Stay in Elderly Patients Following Hip Fracture: A Nationwide Claims Database Analysis.\",\"authors\":\"Seung Hoon Kim, Suk-Yong Jang, Yonghan Cha, Hajun Jang, Bo-Yeon Kim, Hyo-Jung Lee, Gui-Ok Kim\",\"doi\":\"10.4055/cios24193\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Backgroud: </strong>The purpose of our study was to analyze the effects of hospital volume and region on in-hospital and long-term mortality, direct medical costs (DMCs), and length of hospital stay (LOS) in elderly patients following hip fracture, utilizing nationwide claims data.</p><p><strong>Methods: </strong>This retrospective nationwide study sourced its subjects from the Korean National Health Insurance Review and Assessment Service database spanning from January 2011 to December 2018. A generalized estimating equation model with a Poisson distribution and logarithmic link function was used to estimate adjusted odds ratios (aORs) and 95% CIs to assess the association of hospital volume with in-hospital and 1-year mortality, DMCs, and LOS.</p><p><strong>Results: </strong>A total of 172,144 patients were included. Comparing the risk of in-hospital death between high-volume and low-volume hospitals, the risk of in-hospital death was 1.2 times higher at low-volume hospitals (aOR, 1.20; 95% CI, 1.07-1.33; <i>p</i> = 0.002). Additionally, the risk of death at 1 year was 1.05 times higher at low-volume hospitals (aOR, 1.05; 95% CI, 1.01-1.09; <i>p</i> = 0.008) compared to high-volume hospitals. DMCs were 0.84 times lower at low-volume hospitals for in-hospital period (aOR, 0.84; 95% CI, 0.84-0.85; <i>p</i> < 0.001) and 0.87 times lower for 1 year (aOR, 0.87; 95% CI, 0.86-0.88; <i>p</i> < 0.001) compared to high-volume hospitals. In-hospital LOS was 1.21 times longer at low-volume hospitals (aOR, 1.21; 95% CI, 1.20-1.22; <i>p</i> < 0.001) than at high-volume hospitals. In addition, the risk of in-hospital death was 1.22 times higher (aOR, 1.22; 95% CI, 1.12-1.33; <i>p</i> < 0.001) and the risk of 1-year death was 1.07 times higher (aOR, 1.07; 95% CI, 1.04-1.10; <i>p</i> < 0.001) at rural hospitals compared to urban hospitals.</p><p><strong>Conclusions: </strong>Clinicians should focus on improving clinical outcomes for hip fracture patients in low-volume and rural hospital settings, with a specific emphasis on reducing mortality rates.</p>\",\"PeriodicalId\":47648,\"journal\":{\"name\":\"Clinics in Orthopedic Surgery\",\"volume\":\"17 1\",\"pages\":\"80-90\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791489/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinics in Orthopedic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4055/cios24193\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics in Orthopedic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4055/cios24193","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
The Impact of Hospital Volume and Region on Mortality, Medical Costs, and Length of Hospital Stay in Elderly Patients Following Hip Fracture: A Nationwide Claims Database Analysis.
Backgroud: The purpose of our study was to analyze the effects of hospital volume and region on in-hospital and long-term mortality, direct medical costs (DMCs), and length of hospital stay (LOS) in elderly patients following hip fracture, utilizing nationwide claims data.
Methods: This retrospective nationwide study sourced its subjects from the Korean National Health Insurance Review and Assessment Service database spanning from January 2011 to December 2018. A generalized estimating equation model with a Poisson distribution and logarithmic link function was used to estimate adjusted odds ratios (aORs) and 95% CIs to assess the association of hospital volume with in-hospital and 1-year mortality, DMCs, and LOS.
Results: A total of 172,144 patients were included. Comparing the risk of in-hospital death between high-volume and low-volume hospitals, the risk of in-hospital death was 1.2 times higher at low-volume hospitals (aOR, 1.20; 95% CI, 1.07-1.33; p = 0.002). Additionally, the risk of death at 1 year was 1.05 times higher at low-volume hospitals (aOR, 1.05; 95% CI, 1.01-1.09; p = 0.008) compared to high-volume hospitals. DMCs were 0.84 times lower at low-volume hospitals for in-hospital period (aOR, 0.84; 95% CI, 0.84-0.85; p < 0.001) and 0.87 times lower for 1 year (aOR, 0.87; 95% CI, 0.86-0.88; p < 0.001) compared to high-volume hospitals. In-hospital LOS was 1.21 times longer at low-volume hospitals (aOR, 1.21; 95% CI, 1.20-1.22; p < 0.001) than at high-volume hospitals. In addition, the risk of in-hospital death was 1.22 times higher (aOR, 1.22; 95% CI, 1.12-1.33; p < 0.001) and the risk of 1-year death was 1.07 times higher (aOR, 1.07; 95% CI, 1.04-1.10; p < 0.001) at rural hospitals compared to urban hospitals.
Conclusions: Clinicians should focus on improving clinical outcomes for hip fracture patients in low-volume and rural hospital settings, with a specific emphasis on reducing mortality rates.
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