意外外伤性脊髓损伤前后医疗保健使用和费用的5年纵向回顾性队列研究

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2025-09-01 DOI:10.1016/j.apmr.2025.02.012

Paul Lin MS , Adit Doza PhD , Zoe C. Gurney BS , Gianna M. Rodriguez MD , Elham Mahmoudi PhD

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引用次数: 0

摘要

目的：研究美国TSCI事件前后医疗保健使用和成本的趋势设计：回顾性队列研究设置：使用医疗成本研究所2012-2019年的索赔数据，我们确定了诊断为TSCI事件的成年人（45岁以上）（n=251）。根据年龄、性别和一组慢性疾病，我们将2480名没有TSCI的成年人（对照组）与我们的病例进行了匹配。对病例和对照组进行了5年的医疗保健使用和成本分析。我们使用两部分广义估计方程来预测住院、门诊、专业和处方药环境中的任何医疗保健使用/成本和积极使用/成本，以及总医疗保健成本和自付医疗保健成本。参与者：有和没有TSCI的成年人。干预：不适用。结果：与匹配的对照组相比，意外性TSCI与受伤第一年医疗保健总费用和自付费用（不包括受伤月份）的增加相关，OR分别为7.72 （95% CI:5.86, 10.16）和2.02 （95% CI:1.59, 2.55）。费用增加的主要原因是住院病人(55 494美元；95% CI: 40,230美元，76,549美元)和专业服务(17,973美元；95% ci: 13,525美元，23,885美元)。在事故发生后的三年内，TSCI与医疗费用的下降有关，但与对照组相比，TSCI也与更高的医疗费用有关。在第五年，TSCI与门诊人数（7.44至9.01）和住院人数（1.25至1.96）的增加有关。在整个5年的研究期间，对照组的医疗保健使用和成本保持稳定。结论：与对照组相比，TSCI与事件发生当年较高的医疗保健总费用和自付费用相关。第一年之后，TSCI的相关费用急剧下降，但仍略高于对照组。

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A 5-Year Longitudinal Retrospective Cohort Study of Health Care Use and Costs Before and After Incident Traumatic Spinal Cord Injury

Objective

To examine trends in health care use and cost before and after incident traumatic spinal cord injury (TSCI) in the United States.

Design

Retrospective cohort study.

Setting

Using 2012-2019 claims data from the Health Care Cost Institute, we identified adults (45+) with a diagnosis of incident TSCI (n=251). Using age, sex, and a set of chronic conditions, we matched 2480 adults without TSCI (controls) with our cases. Health care use and costs were analyzed for cases and controls for 5 years. We used 2-part generalized estimating equations to predict any health care use/costs and positive use/costs in inpatient, outpatient, professional, and prescription drug settings, as well as total and out-of-pocket health care costs.

Participants

Adults with and without TSCI.

Intervention

Not applicable.

Main Outcomes Measures

Health care use and costs.

Results

Incident TSCI was associated with an increase in total and out-of-pocket costs of health care (excluding the month of injury) during the first year of injury compared with the matched controls by odds ratio=7.72 (95% CI: 5.86, 10.16) and odds ratio=2.02 (95% CI: 1.59, 2.55), respectively. Higher costs were mainly attributed to inpatient ($55,494; 95% CI: $40,230, $76,549) and professional services ($17,973; 95% CI: $13,525, $23,885). TSCI was associated with a decrease in health care costs in the 3 years after the incident but was also associated with higher costs than those of controls. TSCI was associated with an increase in the number of outpatient (7.44-9.01) and inpatient services (1.25-1.96) during the fifth year. Health care use and costs remained stable among controls throughout the 5-year study period.

Conclusions

TSCI was associated with a higher total and out-of-pocket cost of health care in the year of incident compared with controls. After the first year, the associated costs of TSCI sharply declined but remained slightly higher than those of controls.

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.