衰弱指数作为CMS手术髋股骨骨折治疗组合的风险分层工具。

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Alec P Friswold, Devon T Brameier, Faith Selzer, Liqin Wang, Li Zhou, Clay Beagles, Houman Javedan, Michael Weaver, Arvind von Keudell
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引用次数: 0

摘要

目的:确定基于衰弱指数(FI)的综合老年评估预测老年髋部骨折患者住院护理费用的程度,并通过识别成本较高的患者来影响未来捆绑支付模式的风险调整。设计:回顾性队列研究。环境:美利坚合众国的一个学术一级创伤中心。患者选择标准:纳入2018年3月至2020年8月期间接受股骨颈或股骨粗隆间骨折(OTA/AO 31A和31B)手术的所有65岁以上患者,并在受伤入院时记录了虚弱指数。结果测量和比较:主要关注的结果是严重体弱、中度体弱和非体弱患者住院总护理成本的百分比差异。单变量和多变量回归也用于评估虚弱指数与其他人口统计学和临床变量与护理成本的关联。结果:共纳入326例患者。与非体弱患者相比,严重体弱患者的平均住院费用高出20%,中度体弱患者的平均住院费用高出12%。结论:体弱指数评分越高,髋关节和股骨骨折的住院治疗费用增加,这既是一个分类变量,也是一个连续变量。因此,虚弱指数提供了一个潜在的风险调整工具,为未来髋部和股骨骨折的支付捆绑。证据水平:III。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Frailty Index as a Risk Stratification Tool for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundle.

Objectives: To determine the extent to which the Comprehensive Geriatric Assessment based Frailty Index (FI) predicts in-hospital costs of care for older adult hip fracture patients with implications for risk adjustment of future bundled payment models by identifying higher-cost patients.

Design: Retrospective cohort study.

Setting: One academic level 1 trauma center in the United States of America.

Patient selection criteria: Included were all patients over the age of 65 who underwent surgery for a femoral neck or intertrochanteric hip fracture (OTA/AO 31A and 31B) between March 2018 and August 2020 and had a frailty index recorded for the injury admission.

Outcome measures and comparisons: The primary outcome of interest was a percentage difference of in-hospital total cost of care between severely frail, moderately frail, and non-frail patients. Univariate and multivariate regression were also used to evaluate the association of frailty index, along with other demographic and clinical variables, with cost of care.

Results: A total of 326 patients were included. Compared to non-frail patients, the average in-hospital cost was 20% higher for severely frail patients and 12% higher for moderately frail patients (both p<0.05). In univariate regression, FI was found to have a significant association with total cost (β=$1,106 incremental cost per 0.1 increase in FI, p=0.005) and direct cost (β=$586 incremental cost per 0.1 increase in FI, p=0.014).

Conclusion: Higher Frailty Index scores are associated with increased costs of in-hospital treatment for hip and femur fractures as both a categorical and continuous variable. Thus, Frailty Index offers a potential risk adjustment tool for future hip and femur fracture payment bundles.

Level of evidence: III.

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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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