Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1271-1283
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1271
Analysis of hospitalization costs related to fall injuries in elderly patients
Fei-Yue Su, Mei-Ling Fu, Qing-Hua Zhao, Huan-Huan Huang, Di Luo, Ming-Zhao Xiao
Fei-Yue Su, Di Luo, Ming-Zhao Xiao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Mei-Ling Fu, Department of Medical Insurance, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Qing-Hua Zhao, Huan-Huan Huang, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Su FY, Fu ML and Xiao MZ designed the study; Su FY, Huang HH and Luo D performed the experiments and collected the data; Su FY analyzed the data and wrote the manuscript; and Zhao QH and Xiao MZ reviewed and edited the manuscript; all authors read and approved the final manuscript.
Supported by The National Key Research and Development Project, No. 2020YFC2005900.
Institutional review board statement: The study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. 2019-288).
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The data underlying this article were provided by The First Affiliated Hospital of Chongqing Medical University and the Jinshan Branch of The First Affiliated Hospital of Chongqing Medical University under licence. Data will be shared on request to the corresponding author with permission of The First Affiliated Hospital of Chongqing Medical University and the Jinshan Branch of The First Affiliated Hospital of Chongqing Medical University.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Zhao Xiao, MM, Chief Doctor, Professor, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. xmz.2004@163.com
Received: August 13, 2020
Peer-review started: August 13, 2020
First decision: November 23, 2020
Revised: December 3, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 26, 2021
Processing time: 177 Days and 1.1 Hours
Abstract
BACKGROUND

With the aging world population, the incidence of falls has intensified and fall-related hospitalization costs are increasing. Falls are one type of event studied in the health economics of patient safety, and many developed countries have conducted such research on fall-related hospitalization costs. However, China, a developing country, still lacks large-scale studies in this area.

AIM

To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based, cost-related groupings.

METHODS

A retrospective study was conducted. Patient information and cost data for elderly inpatients (age ≥ 60 years, n = 3362) who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China. Quantile regression (QR) analysis was used to identify the factors related to fall-related hospitalization costs. A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes.

RESULTS

The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB, and the reimbursement rate of medical benefit funds was 51.0% (92039709.52 RMB/180479203.03 RMB). The medical material costs were the highest component of the total hospitalization cost, followed (in order) by drug costs, test costs, treatment costs, integrated medical service costs and blood transfusion costs The QR results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and age, length of stay, operation type, wound position and wound type were the most important influencing factors in the model. Furthermore, the cost of each combination varied significantly.

CONCLUSION

Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

Keywords: Falls; Elderly; Hospitalization costs; Quantile regression model; Decision tree model; Prevention

Core Tip: This retrospective study investigated the composition and factors of the hospitalization costs of fall-related injuries in elderly inpatients and established a factor-based, cost-related group. The total hospitalization costs were 180479203.03 RMB. The quantile regression (QR) results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and the cost of each combination varied significantly. Our grouping model of hospitalization costs clearly reflects the key factors affecting hospitalization costs.