Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled payment

被引：49
作者：
Johnson D.J. [1 ]
Greenberg S.E. [1 ]
Sathiyakumar V. [1 ]
Thakore R. [1 ]
Ehrenfeld J.M. [1 ]
Obremskey W.T. [1 ]
Sethi M.K. [1 ]
机构：
[1] The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Suite 4200, South Tower, MCE, Nashville, 37221, TN
来源：
Journal of Orthopaedics and Traumatology | 2015年 / 16卷 / 3期
关键词：
Charlson Comorbidity Index; Costs; Length of stay (LOS);
D O I：
10.1007/s10195-015-0337-z
中图分类号：
学科分类号：
摘要：
Background: The aim of this study is to investigate how the Charlson Comorbidity Index (CCI) scores contribute to increased length of stay (LOS) and healthcare costs in hip fracture patients. Materials and methods: Through retrospective analysis at an Urban level I trauma center, charts for all patients over the age of 60 years who presented with low-energy hip fracture were evaluated. 615 patients who underwent operative fixation of hip fracture or hemiarthroplasty secondary to hip fracture were identified using Current Procedural Terminology (CPT) codes search and included in the study. Data was collected on patient demographics, medical comorbidities, and hospitalization length; from this, the CCI score and the cost to the institution (with an average cost/day of inpatient stay of $4,530) were calculated. Results: Multivariate linear regression analysis modeled the length of stay as a function of CCI score. Each unit increase in the CCI score corresponded to an increase in length of hospital stay and hospital costs incurred [effect size = 0.21; (0.0434–0.381); p = 0.014]. Patients with a CCI score of 2 (compared to a baseline CCI score of 0), on average, stayed 1.92 extra days in the hospital, and incurred $8,697.60 extra costs. Conclusions: The CCI score is associated with length of stay and hospital costs incurred following treatment for hip fracture. The CCI score may be a useful tool for risk assessment in bundled payment plans. Level of evidence: Level III. © 2015, The Author(s).
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页码：209 / 213
页数：4
相关论文
共 13 条
[1]  
Braithwaite R.S., Col N.F., Wong J.B., Estimating hip fracture morbidity, mortality and costs, J Am Geriatr Soc, 51, 3, pp. 364-370, (2003)
[2]  
Nikkel L.E., Fox E.J., Black K.P., Et al., Impact of comorbidities on hospitalization costs following hip fracture, J Bone Joint Surg Am, 94, 1, pp. 9-17, (2012)
[3]  
Birkmeyer J.D., Gust C., Baser O., Et al., Medicare payments for common inpatient procedures: implications for episode-based payment bundling, Health Serv Res, 45, 6, pp. 1783-1795, (2010)
[4]  
Sood N., Huckfeldt P.J., Escarce J.J., Et al., Medicare’s bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin, Health Aff (Millwood), 30, 9, pp. 1708-1717, (2011)
[5]  
Bosco J.A., Karkenny A.J., Hutzler L.H., Et al., Cost burden of 30-day readmissions following medicare total hip and knee arthroplasty, J Arthroplast, 29, 5, pp. 903-905, (2014)
[6]  
Garcia A.E., Bonnaig J.V., Yoneda Z.T., Et al., Patient variables which may predict length of stay and hospital costs in elderly patients with hip fracture, J Orthop Trauma, 26, 11, pp. 620-623, (2012)
[7]  
Kirkland L.L., Kashiwagi D.T., Burton M.C., Et al., The Charlson Comorbidity Index score as a predictor of 30-day mortality after hip fracture surgery, Am J Med Qual, 26, 6, pp. 461-467, (2011)
[8]  
Souza R.C., Pinheiro R.S., Coeli C.M., Et al., The Charlson Comorbidity Index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses, Cad Saude Publica, 24, 2, pp. 315-322, (2008)
[9]  
Neuhaus V., King J., Hageman M.G., Et al., Charlson comorbidity indices and in-hospital deaths in patients with hip fractures, Clin Orthop Relat Res, 471, 5, pp. 1712-1719, (2013)
[10]  
Voskuijl T., Hageman M., Ring D., Higher Charlson Comorbidity Index Scores are associated with readmission after orthopaedic surgery, Clin Orthop Relat Res, 472, 5, pp. 1638-1644, (2014)
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