Catastrophic Health Expenditures Associated With Open Reduction Internal Fixation of Distal Radius Fractures.

PURPOSE: Distal radius fracture is one of the most common upper-extremity traumatic injuries. These injuries result in time off work and potential financial consequences for patients. Therefore, we aimed to understand the risk of catastrophic health expenditures (CHEs) after open reduction and internal fixation of distal radius fractures and examine the association between patient characteristics and the risk of CHE. METHODS: We used data from patients undergoing open reduction and internal fixation of a distal radius fracture from a large, urban, level I trauma center (2018-2020). The risk of CHE was defined as out-of-pocket expenses of ≥40% of postsubsistence income. We used multivariable logistic regression to assess the impact of age, sex, race, and insurance status on the risk of CHE. RESULTS: In our cohort of 394 patients, 121 patients (30.7%) were at risk of CHE after their distal radius fracture. After controlling for patient characteristics and insurance status, patients aged 26-34 years were 5.7 times more likely to be at risk of CHE (odds ratio, 5.73; 95% CI, 1.81-18.13) than patients aged ≥65 years. Patients who were uninsured were six times more likely to be at risk of CHE than patients with employer-sponsored health insurance (odds ratio, 6.02; 95% CI, 1.94-18.66). Lastly, non-White patients were at a higher risk of CHE (odds ratio, 3.63; 95% CI, 1.70-7.79) than White patients. CONCLUSIONS: Distal radius fractures are unexpected and place patients at risk of financial harm, with one in three patients at risk of CHEs. Policies aimed at minimizing cost-sharing after traumatic injury may help alleviate the financial consequences of health care delivery and reduce disparities. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and Decision Analysis II.

Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma.

BACKGROUND: Health-care expenditures are a leading contributor to financial hardship in the United States. Traumatic orthopaedic injuries are unpredictable and result in substantial expense. Our objectives were to quantify the catastrophic health expenditure (CHE) risk of patients with orthopaedic trauma and to examine the impact of insurance status, socioeconomic status, sex, and race on CHE. METHODS: We identified all isolated lower-extremity orthopaedic trauma cases at a safety-net, Level-1 trauma center from 2018 to 2020. We queried an institutional charge database to obtain total hospital charges, insurance status, and ZIP Code to determine out-of-pocket (OOP) expenditures. To evaluate financial hardship, we calculated the CHE risk as defined by the World Health Organization's threshold of OOP expenditures, ≥40% of estimated household post-subsistence income. RESULTS: In our cohort of 2,535 patients, 33% experienced a risk of CHE. A risk of CHE was experienced by 99% of patients who were uninsured, 35% of patients with private insurance, 2% of patients with Medicare, and 0% of patients with Medicaid. Multivariable regression modeling showed that patients who were uninsured were significantly more likely to experience a risk of CHE compared with patients with private insurance (odds ratio, 107.68 [95% confidence interval, 37.20 to 311.68]; p < 0.001). CONCLUSIONS: One-third of patients with lower-extremity orthopaedic trauma experience a risk of CHE, with patients who are uninsured facing a disproportionately higher risk of CHE compared with patients who are insured. Our results suggest that the expansion of public insurance options may provide substantial financial protection for those at the greatest risk for CHE. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Visual Motion and Form Integration in the Behaving Ferret.

Ferrets have become a standard animal model for the development of early visual stages. Less is known about higher-level vision in ferrets, both during development and in adulthood. Here, as a step towards establishing higher-level vision research in ferrets, we used behavioral experiments to test the motion and form integration capacity of adult ferrets. Motion integration was assessed by training ferrets to discriminate random dot kinematograms (RDK) based on their direction. Task difficulty was varied systematically by changing RDK coherence levels, which allowed the measurement of motion integration thresholds. Form integration was measured analogously by training ferrets to discriminate linear Glass patterns of varying coherence levels based on their orientation. In all experiments, ferrets proved to be good psychophysical subjects that performed tasks reliably. Crucially, the behavioral data showed clear evidence of perceptual motion and form integration. In the monkey, motion and form integration are usually associated with processes occurring in higher-level visual areas. In a second set of experiments, we therefore tested whether PSS, a higher-level motion area in the ferret, could similarly support motion integration behavior in this species. To this end, we measured responses of PSS neurons to RDK of different coherence levels. Indeed, neurometric functions for PSS were in good agreement with the behaviorally derived psychometric functions. In conclusion, our experiments demonstrate that ferrets are well suited for higher-level vision research.