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1.
PLoS One ; 15(8): e0238258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853228

RESUMO

This study aims to understand the difference in trauma patients' use of health services in Korea according to insurance type and the Injury Severity Score. Andersen's behavioral model of health service use is employed to identify the factors influencing their use. Claims data from January 1 to December 31, 2016 were extracted from both the Health Insurance Review and Assessment Service and the automobile insurance screening center for all the medical treatments identified with the Korean Triage and Acuity Scale and Injury Severity Score. Using the Health Insurance Review and Assessment Service's remote statistical analysis system, hierarchical regression and negative binomial analyses were conducted to determine the effect of predisposing, enabling, and need factors on health service use. The results demonstrate that the use of Korean health services is relatively equitable since medical expenses for trauma patients are greatly influenced by need factors. However, the length of time trauma patients stay in the hospital appears to differ according to insurance type. This study suggests that healthcare policies need to increase coverage benefits and improve medical billing for patients with severe trauma, as well as develop a more robust screening system for patients with mild to moderate impairments.


Assuntos
Serviços de Saúde/economia , Seguro Saúde/economia , Ferimentos e Lesões/economia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Cobertura do Seguro/economia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade da Assistência à Saúde/economia , República da Coreia , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-32630384

RESUMO

The evidence of the economic burden of road traffic injuries (RTIs) in Nepal is limited. The most recent study, conducted in 2008, is now considered outdated because there has been a rapid increase in vehicle numbers and extensive road building over the last decade. This study estimated the current economic costs of RTIs in Nepal, including the direct costs, productivity costs, and valuation of pain, grief, and suffering. An incidence-based cost-of-illness analysis was conducted from a societal perspective, employing a bottom-up approach using secondary data. All costs incurred by the patients, their family members, and costs to society were estimated, with sensitivity analyses to consider uncertainty around the data estimates available. Productivity loss was valued using the human capital approach. The total costs of RTIs in 2017 were estimated at USD 122.88 million. Of these, the costs of productivity loss were USD 91.57 million (74.52%) and the pain, grief, and suffering costs were USD 18.31 million (14.90%). The direct non-medical costs were USD 11.50 million (9.36%) whereas the direct medical costs were USD 1.50 million (1.22%). The economic costs of RTIs increased by threefold since 2007 and are equivalent to 1.52% of the gross national product, indicating the growing national financial burden associated with preventable RTIs.


Assuntos
Acidentes de Trânsito , Efeitos Psicossociais da Doença , Ferimentos e Lesões , Custos e Análise de Custo , Eficiência , Humanos , Incidência , Nepal/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
3.
J Surg Res ; 254: 398-407, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32540507

RESUMO

BACKGROUND: Bicycle injuries continue to cause significant morbidity in the United States. How insurance status affects outcomes in children with bicycle injuries has not been defined. We hypothesized that payer status would not impact injury patterns or outcomes in pediatric bicycle-related accidents. METHODS: The National Trauma Data Bank was used to identify pediatric (≤18 y) patients involved in bicycle-related crashes admitted in year 2016. Patients with private insurance were compared with all others (uninsured, Medicaid, and Medicare). RESULTS: There were 5619 patients that met study criteria. Of these, 2500 (44%) had private insurance. Privately insured were older (12 y versus 11, P < 0.001), more likely to be white (77% versus 56%, P < 0.001), and more likely to wear a helmet (26% versus 9%, P < 0.001). On multivariate analysis, factors associated with traumatic brain injury included age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.06-1.08; P < 0.001) and helmet use (OR, 0.64; 95% CI, 0.55-0.74; P < 0.001). Patients without private insurance were significantly less likely to wear a helmet (OR, 0.52; 95% CI, 0.44-0.63; P < 0.001). Uninsured patients had significantly higher odds of a fatal injury (OR, 4.43; 95% CI, 1.52-12.92; P = 0.006). CONCLUSIONS: Uninsured children that present to a trauma center after a bicycle accident are more likely to die. Although helmet use reduced the odds of traumatic brain injury, minorities and children without private insurance were less likely to be helmeted. Public health interventions should increase helmet access to children without private insurance, especially uninsured children.


Assuntos
Ciclismo/lesões , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Sistema de Registros , Ferimentos e Lesões/mortalidade , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/etiologia
4.
Value Health ; 23(6): 705-709, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540227

RESUMO

OBJECTIVE: Trauma care provides value to the critically injured. Our aim was to assess whether trauma team involvement adds value to the care of minimally injured patients and to define its costs. METHODS: Minimally injured patients admitted to a trauma center were propensity matched and compared by involvement versus no involvement of the trauma service (TS). Demographics, injury severity, complications, length of emergency department stay, mortality, and hospital costs and charges were studied. RESULTS: A total of 1253 patients were enrolled, with 308 propensity matched to the following groups: TS (n = 102) and no TS (n = 206). TS demonstrated a 30% increase in total charges and costs with no difference in complications. TS did demonstrate decreased time in the emergency department but had an increased delay to operation. Findings were similar when stratified for only lower extremity injuries. CONCLUSIONS: TS involvement for minimally injured patients does not increase value. Reducing TS involvement while avoiding trauma undertriage may reduce costs to the healthcare system without affecting outcomes.


Assuntos
Serviço Hospitalar de Emergência/economia , Custos Hospitalares/estatística & dados numéricos , Centros de Traumatologia/economia , Ferimentos e Lesões/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Ferimentos e Lesões/economia , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
5.
J Surg Res ; 254: 206-216, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32470653

RESUMO

BACKGROUND: Domestic and intimate partner violence (DV) are under-reported causes of injury. We describe the health care utilization of DV patients, hypothesizing they are at increased risk of mortality. METHODS: We queried the 2014 Nationwide Emergency Department Sample for adult patients (18 y and older) with a primary diagnosis of trauma. DV was abstracted using International Statistical Classification of Diseases, ninth Revision codes for partner or spouse intimate violence, abuse, or neglect. The primary outcome was mortality; secondary outcomes included admission rates and charges. RESULTS: Among 14 million trauma patients, 654,356 (5.0%) had a diagnosis of DV. Compared with other trauma patients, DV patients were younger (34.6 versus 46.8 y, P < 0.001), more often male (69.5% versus 50.1%, P < 0.001), and more likely to be uninsured (31.5% versus 15.6%, P < 0.001). 9154 (1.4%) were injured because of intimate partner violence, of which 90.2% were female. Drug and alcohol abuse (22.2%), anxiety (1.8%), and depression (1.3%) were high among all DV trauma patients. DV emergency department charges were higher ($4462 versus $2,871, P < 0.001). In adjusted analyses, DV trauma patients had 2.1 higher odds of mortality (aOR: 2.31, P < 0.001). DV trauma patients were also associated with a $1516 increase in emergency department charges compared with non-DV trauma patients (95% CI: $1489-$1,542, P < 0.001). CONCLUSIONS: Injuries related to all types of DV are emerging as a public health crisis among both genders. To mitigate under-reporting, it is important to identify at-risk patients and provide them with appropriate resources.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Estupro/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia
6.
N Z Med J ; 133(1514): 41-48, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379738

RESUMO

AIMS: The purpose of this study is to audit the numbers of non-residents requiring orthopaedic admission to Dunedin and Southland Hospitals and determine the effects of increasing tourist numbers on healthcare resources. METHOD: All non-resident orthopaedic admissions to Dunedin Hospital from January 2005 to December 2017 and Invercargill Hospital from January 2011 to December 2017 were analysed with respect to country of residence, mechanism of injury, primary diagnosis and case weights consumed. The results were combined with figures from 1997-2004 to give a 21-year series for Dunedin Hospital. RESULTS: There has been a significant increase in the number of admissions and case weights (CW) over the past 21 years at Dunedin Hospital (p<0.001). The most common mechanisms of injury were snow sports at Dunedin Hospital and falls for Southland Hospital. Between 2011 and 2017 there were on average 50 non-resident admissions per year (92.9 CW/year) to Dunedin Hospital and 74 admissions (120.7 CW/year) in Southland. CONCLUSION: Increasing tourist numbers have resulted in an increase number of orthopaedic admissions to Dunedin Hospital over the last two decades although it remains a small proportion of the total workload. Southland Hospital is relatively more affected. These patients represent an annual cost in excess of $1,000,000 to Southern DHB.


Assuntos
Hospitais/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Ferimentos e Lesões/epidemiologia , Ásia/etnologia , Austrália/etnologia , Economia Hospitalar/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Humanos , Luxações Articulares/epidemiologia , Auditoria Médica , Nova Zelândia/epidemiologia , Ortopedia/organização & administração , Ortopedia/tendências , Traumatismos da Coluna Vertebral/epidemiologia , Viagem/estatística & dados numéricos , Reino Unido/etnologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/etiologia
7.
JAMA Netw Open ; 3(5): e205171, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32427321

RESUMO

Importance: Despite the highest injury rates worldwide, formal medical care is not often sought after injuries in Sub-Saharan Africa. Unaffordable costs associated with trauma care might inhibit injured patients from seeking care. Objectives: To (1) determine the injury epidemiology in Cameroon using population-representative data, (2) identify the barriers to use of formal health care after injury, and (3) determine the association between use of care and economic outcomes after injury. Design, Setting, and Participants: This mixed-methods, cross-sectional study included a population-representative, community-based survey and nested qualitative semistructured interviews in the urban-rural Southwest Region of Cameroon. Three-stage cluster sampling was used to select target households. Data were collected from January 3 to March 14, 2017, and analyzed from March 3, 2017, to March 3, 2019. Exposures: Injuries occurring in the preceding 12 months. Main Outcomes and Measures: Postinjury use of health care services, disability, and economic outcomes. All survey data were adjusted for cluster sampling. Results: Of 1551 total households approached, 1287 (83.0%) were surveyed for a total sample size of 8065 participants. The 8065 individuals surveyed included 4181 women (52.0%), with a mean age of 23.9 (standard error [SE], 0.2) years. A total of 503 injuries were identified among 471 unique participants, including 494 nonfatal injuries. Among these, 165 (34.6%) did not seek formal medical services. Disability occurred after 345 injuries (68.6%) and resulted in 11 941 lost days of work in the sample. Family economic hardship after injury was substantially increased among the injured cohort who used formal medical care. Injuries brought to formal medical care, compared with those that were note, incurred higher mean treatment costs ($101.08 [SE, $236.23] vs $12.13 [SE, $36.78]; P < .001), resulted in higher rates of lost employment (19.9% [SE, 3.6%] vs 5.6% [SE, 1.6%]; P = .004), and more frequently led affected families to use economic coping strategies, such as borrowing money (26.2% [SE, 2.7%] vs 7.1% [SE, 1.2%]; P < .001). After adjusting for age and severity, use of formal medical care in Cameroon was independently associated with severe economic hardship after injury, defined as a new inability to afford food or rent (adjusted odds ratio, 1.67; 95% CI, 1.05-2.65). Conclusions and Relevance: In this study, injury in Southwestern Cameroon was associated with significant disability and lost productivity. Formal medical treatment of injury was associated with significant financial consequences for households of injured patients. Primary prevention of road traffic injuries and financial restructuring of emergency care could improve trauma care access in Cameroon and reduce the societal effects of injury.


Assuntos
Acesso aos Serviços de Saúde/economia , Ferimentos e Lesões/economia , Ferimentos e Lesões/terapia , Camarões/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Entrevistas como Assunto , Masculino , Revisão da Utilização de Recursos de Saúde , Ferimentos e Lesões/epidemiologia
8.
Am J Surg ; 220(3): 511-517, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32354603

RESUMO

BACKGROUND: Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients. METHODS: We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013). RESULTS: Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients. CONCLUSIONS: ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study.


Assuntos
Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act , Ferimentos e Lesões/economia , Ferimentos e Lesões/etnologia , Adulto , California , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Traumatologia/economia
9.
PLoS One ; 15(4): e0231025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251480

RESUMO

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability.


Assuntos
Acidentes de Trânsito/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Advogados/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/economia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Fatores de Tempo , Vitória/epidemiologia , Ferimentos e Lesões/economia , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32224960

RESUMO

This study aimed to provide a detailed overview of the health care and productivity costs of non-fatal road traffic injuries by road user type. In a cohort study in the Netherlands, adult injury patients admitted to a hospital as a result of a traffic accident completed questionnaires 1 week and 1, 3, 6, 12 and 24 months after injury, including the iMTA Medical Consumption and Productivity Cost Questionnaire. In-hospital, post-hospital medical costs and productivity costs were calculated up to two years after traffic injury. In total, 1024 patients were included in this study. The mean health care costs per patient were € 8200. The mean productivity costs were € 5900. Being female, older age, with higher injury severity and having multiple comorbidities were associated with higher health care costs. Higher injury severity and being male were associated with higher productivity costs. Pedestrians aged ≥ 65 years had the highest mean health care costs (€ 18,800) and motorcyclists the highest mean productivity costs (€ 9000). Bicycle injuries occurred most often in our sample (n = 554, 54.1%) and accounted for the highest total health care and productivity costs. Considering the high proportion of total costs incurred by bicycle injuries, this is an important area for the prevention of traffic injuries.


Assuntos
Acidentes de Trânsito , Eficiência , Custos de Cuidados de Saúde , Ferimentos e Lesões , Acidentes de Trânsito/economia , Adulto , Idoso , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Países Baixos/epidemiologia , Ferimentos e Lesões/economia
11.
PLoS One ; 15(4): e0232243, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339213

RESUMO

In the United States (US), the lifetime incidence of incarceration is 6.6%, exceeding that of any other nation. Compared to the general US population, incarcerated individuals are disproportionally affected by chronic health conditions, mental illness, and substance use disorders. Barriers to accessing medical care are common in correctional facilities. We sought to characterize the local incarcerated patient population and explore barriers to medical care in these patients. We conducted a retrospective, observational cohort study by reviewing the medical records of incarcerated patients presenting to the adult emergency department (ED) of a single academic, tertiary care facility with medical or psychiatric (med/psych) and trauma-related emergencies between January 2012 and December 2014. Data on demographics, medical complexity, trauma intentionality, and barriers to medical care were analyzed using descriptive statistics, unpaired student's t-test or one-way analysis of variance for continuous variables, and chi-square analysis or Fisher's exact test as appropriate. Trauma patients were younger with fewer medical comorbidities and were less likely to be admitted to the hospital than med/psych patients. 47.8% of injuries resulted from violence or were self-inflicted. Most trauma-related complaints were managed by the emergency medicine physician in the ED. While barriers to medical care were not correlated with hospital admission, 5.4% of med/psych and 2.9% of trauma patients reported barriers as a contributing factor to the ED encounter. Med/psych patients commonly reported a lack of access to medications, while trauma patients reported a delay in medical care. Trauma-related presentations were less medically complex than med/psych-related complaints. Medical management of most injuries required no hospital resources outside of the ED, indicating a potential role for outpatient management of trauma-related complaints. Additional opportunities for health care improvement and cost savings include the implementation of programs that target violence, prevent injuries, and promote the continuity of medical care while incarcerated.


Assuntos
Redução de Custos/economia , Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Tratamento de Emergência/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Emergências/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/economia , Ferimentos e Lesões/terapia , Adulto Jovem
12.
PLoS One ; 15(3): e0230382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191749

RESUMO

OBJECTIVE: People in the Netherlands are legally allowed to celebrate New Year's Eve with consumer fireworks. The aim of this study was to provide detailed information about the patient and injury characteristics, medical and societal costs, and clinical and functional outcome in patients with injuries resulting from this tradition. METHODS: A multicenter, prospective, observational case series performed in the Southwest Netherlands trauma region, which reflects 15% of the country and includes a level I trauma center, a specialized burn center, a specialized eye hospital, and 13 general hospitals. All patients with any injury caused by consumer fireworks, treated at a Dutch hospital between December 1, 2017 and January 31, 2018, were eligible for inclusion. Exclusion criteria were unknown contact information or insufficient understanding of Dutch or English language. The primary outcome measure was injury characteristics. Secondary outcome measures included treatment, direct medical and indirect societal costs, and clinical and functional outcome until one year after trauma. RESULTS: 54 out of 63 eligible patients agreed to participate in this study. The majority were males (N = 50; 93%), 50% were children below 16 years of age, and 46% were bystanders. Injuries were mainly located to the upper extremity or eyes, and were mostly burns (N = 38; 48%) of partial thickness (N = 32; 84%). Fifteen (28%) patients were admitted and 11 (20%) patients needed surgical treatment. The mean total costs per patient were €6,320 (95% CI €3,400 to €9,245). The most important cost category was hospital admission. Only few patients reported complaints in patient-reported quality of life and functional outcome after 12 months follow-up. CONCLUSION: This study found that young males are most vulnerable for fireworks injuries and that most injuries consist of burns, located to the arm and hand, and eye injuries. On the long-term only few patients experienced reduced quality of life and functional limitations.


Assuntos
Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Atividades Cotidianas , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Instituições Acadêmicas , Fatores de Tempo , Resultado do Tratamento , Trabalho , Ferimentos e Lesões/economia , Adulto Jovem
13.
PLoS One ; 15(3): e0230641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210472

RESUMO

AIM: The aim of this study was to determine prognostic factors for medical and productivity costs, and return to work (RTW) during the first two years after trauma in a clinical trauma population. METHODS: This prospective multicentre observational study followed all adult trauma patients (≥18 years) admitted to a hospital in Noord-Brabant, the Netherlands from August 2015 through November 2016. Health care consumption, productivity loss and return to work were measured in questionnaires at 1 week, 1, 3, 6, 12 and 24 months after injury. Data was linked with hospital registries. Prognostic factors for medical costs and productivity costs were analysed with log-linked gamma generalized linear models. Prognostic factors for RTW were assessed with Cox proportional hazards model. The predictive ability of the models was assessed with McFadden R2 (explained variance) and c-statistics (discrimination). RESULTS: A total of 3785 trauma patients (39% of total study population) responded to at least one follow-up questionnaire. Mean medical costs per patient (€9,710) and mean productivity costs per patient (€9,000) varied widely. Prognostic factors for high medical costs were higher age, female gender, spine injury, lower extremity injury, severe head injury, high injury severity, comorbidities, and pre-injury health status. Productivity costs were highest in males, and in patients with spinal cord injury, high injury severity, longer length of stay at the hospital and patients admitted to the ICU. Prognostic factors for RTW were high educational level, male gender, low injury severity, shorter length of stay at the hospital and absence of comorbidity. CONCLUSIONS: Productivity costs and RTW should be considered when assessing the economic impact of injury in addition to medical costs. Prognostic factors may assist in identifying high cost groups with potentially modifiable factors for targeted preventive interventions, hence reducing costs and increasing RTW rates.


Assuntos
Efeitos Psicossociais da Doença , Retorno ao Trabalho/economia , Ferimentos e Lesões/patologia , Adolescente , Adulto , Idoso , Feminino , Nível de Saúde , Humanos , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Traumatismos da Medula Espinal/economia , Traumatismos da Medula Espinal/patologia , Inquéritos e Questionários , Ferimentos e Lesões/economia , Adulto Jovem
14.
Occup Environ Med ; 77(7): 470-477, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32220918

RESUMO

OBJECTIVE: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. METHODS: We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. RESULTS: The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I 2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. CONCLUSIONS: The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.


Assuntos
Doenças Profissionais/economia , Traumatismos Ocupacionais/economia , Retorno ao Trabalho/economia , Indenização aos Trabalhadores/economia , Austrália , Fraturas Ósseas/economia , Humanos , Transtornos Mentais/economia , Motivação , Doenças Musculoesqueléticas/economia , Retorno ao Trabalho/psicologia , Ferimentos e Lesões/economia
15.
Rev Bras Epidemiol ; 23: e200015, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159626

RESUMO

OBJECTIVE: To study associated factors with loss productivity in people involved road traffic accidents (RTA). METHODS: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. RESULTS: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). CONCLUSION: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Efeitos Psicossociais da Doença , Eficiência , Licença Médica/estatística & dados numéricos , Ferimentos e Lesões/economia , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Licença Médica/economia , Índices de Gravidade do Trauma , Ferimentos e Lesões/etiologia
16.
JAMA Netw Open ; 3(2): e200157, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32108892

RESUMO

Importance: Trauma is an expensive and unpredictable source of out-of-pocket spending for American families. The Patient Protection and Affordable Care Act (ACA) sought to improve financial protection by expanding health insurance coverage, but its association with health care spending for patients with traumatic injury remains largely unknown. Objective: To evaluate the association of ACA implementation with out-of-pocket spending, premiums, and catastrophic health expenditures (CHE) among adult patients with traumatic injury. Design, Setting, and Participants: Data from a nationally representative sample of US adults aged 19 to 64 years who had a hospital stay or emergency department visit for a traumatic injury from January 2010 to December 2017 were analyzed using the Medical Expenditure Panel Survey. Multivariable generalized linear models were used to evaluate changes in spending after ACA implementation. Additionally, 4 income subgroups were evaluated based on ACA thresholds for program eligibility: lowest-income patients (earning 138% or less of the federal poverty level [FPL]), low-income patients (earning 139% to 250% of the FPL), middle-income patients (earning 251% to 400% of the FPL), and high-income patients (earning more than 400% of the FPL). Data were analyzed from February to December 2019. Exposures: Implementation of the ACA, beginning January 1, 2014. Main Outcomes and Measures: Out-of-pocket spending, premium spending, out-of-pocket plus premium spending, and likelihood of experiencing CHE, defined as out-of-pocket plus premium spending exceeding 19.5% of family income. Results: Of the 6288 included patients, 2995 (weighted percentage, 51.3%) were male, and the mean (SD) age was 41.4 (12.8) years. Implementation of the ACA was associated with 31% lower odds of CHE (adjusted odds ratio, 0.69; 95% CI, 0.54 to 0.87; P = .002). Changes were greatest in lowest-income patients, who experienced 30% lower out-of-pocket spending (adjusted percentage change, -30.4%; 95% CI, -46.6% to -9.4%; P = .01), 26% lower out-of-pocket plus premium spending (adjusted percentage change, -26.3%; 95% CI, -41.0% to -8.1%; P = .01), and 39% lower odds of CHE (adjusted odds ratio, 0.61; 95% CI, 0.44 to 0.84; P = .002). Low-income patients experienced decreased out-of-pocket spending and out-of-pocket plus premium spending but no changes in CHE, while middle-income and high-income patients experienced no significant changes in any spending outcome. In the post-ACA period, 1 in 11 of all patients with traumatic injury and 1 in 5 with the lowest incomes continued to experience CHE each year. Conclusions and Relevance: Implementation of the ACA was associated with improved financial protection for US adults with traumatic injury, especially lowest-income individuals targeted by the law's Medicaid expansions. Despite these gains, injured patients remain at risk of financial strain.


Assuntos
Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Ferimentos e Lesões/economia , Adulto , Feminino , Humanos , Renda/classificação , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Pobreza , Estados Unidos
17.
Medicine (Baltimore) ; 99(6): e19027, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028413

RESUMO

To evaluate disparities in the National Institute of Health (NIH) trauma research funding.Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. The current trauma research funding is not commensurate with the extent of the burden of trauma on the US population.In this qualitative study, the National Institutes of Health's Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) data were reviewed. The burden of traumatic injury on the US and the NIH trauma research funding was examined and compared with other diseases.In 2018, the NIH funded an estimated $639 million to traumatic injury research projects, <2% of the NIH budget. Comparatively, the NIH funded an estimated $6.3 billion towards cancer research in 2018. Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer.In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.


Assuntos
Pesquisa Biomédica/economia , National Institutes of Health (U.S.) , Ferimentos e Lesões/terapia , Pesquisa Biomédica/estatística & dados numéricos , Humanos , National Institutes of Health (U.S.)/economia , National Institutes of Health (U.S.)/estatística & dados numéricos , Apoio à Pesquisa como Assunto , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
18.
J Trauma Nurs ; 27(1): 29-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895316

RESUMO

Traumatic injury survivors often face a difficult recovery. Surgical and invasive procedures, prolonged monitoring in the intensive care unit (ICU), and constant preventive vigilance by medical staff guide standards of care to promote positive outcomes. Recently, patients with traumatic injuries have benefited from early mobilization, a multidisciplinary approach to increasing participation in upright activity and walking. The purpose of this project was to determine the impact of an early mobility program in the trauma ICU on length of stay (LOS), ventilator days, cost, functional milestones, and rehabilitation utilization. A quality improvement project compared outcomes and cost before and after the implementation of an early mobility program. The trauma team assigned daily mobility levels to trauma ICU patients. Nursing and rehabilitation staff collaborated to set daily goals and provide mobility-based interventions. Forty-four patients were included in the preintervention group and 43 patients in the early mobility group. Physical therapy and occupational therapy were initiated earlier in the early mobilization group (p = .044 and p = .026, respectively). Improvements in LOS, duration of mechanical ventilation, time to out-of-bed activity and walking, and discharge disposition were not significant. There were no adverse events related to the early mobility initiative. Activity intolerance resulted in termination of 7.1% of mobility sessions. The development and initiation of a trauma-specific early mobility program proved to be safe and reduce patient care costs. In addition, the program facilitated earlier initiation of physician and occupational therapies. Although not statistically significant, retrospective data abstraction provides evidence of fewer ICU and total hospital days, earlier extubations, and greater proactive participation in functional activities.


Assuntos
Deambulação Precoce/economia , Deambulação Precoce/enfermagem , Unidades de Terapia Intensiva/economia , Melhoria de Qualidade/economia , Centros de Traumatologia/economia , Ferimentos e Lesões/economia , Ferimentos e Lesões/enfermagem , Adulto , Idoso , Currículo , Deambulação Precoce/estatística & dados numéricos , Educação Médica Continuada/organização & administração , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos
20.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959926

RESUMO

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Assuntos
Crime/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Crime/economia , Bases de Dados Factuais , Dinamarca/epidemiologia , Prescrições de Medicamentos/economia , Escolaridade , Feminino , Hospitalização/economia , Hospitais Públicos/economia , Humanos , Lactente , Seguro Saúde/economia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Satisfação Pessoal , Seguridade Social/economia , Ferimentos e Lesões/economia , Adulto Jovem
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