Predictors of healthy days at home: Benchmarking long-term outcomes in geriatric trauma.

J Trauma Acute Care Surg

From the Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (M.C.-A., C.B.S., J.C.E., C.W., S.N., R.A., Z.C., A.S., J.M.H.), Brigham and Women's Hospital, Harvard Medical School; Center for Surgery and Public Health, Department of Surgery (M.C.-A., C.K.Z., M.J., Z.C., A.S., J.M.H.), Brigham and Women's Hospital, Harvard Medical School; Harvard T. H. Chan School of Public Health (M.C.-A., C.K.Z., M.J., Z.C., A.S., J.M.H.), Boston, Massachusetts; and Department of Surgery (C.K.Z.), Duke University Medical Center, Durham, North Carolina.

Published: December 2024

AI Article Synopsis

  • Quality benchmarking in geriatric trauma care has shifted from short-term outcomes like morbidity and mortality to long-term metrics, with healthy days at home (HDAH) emerging as a useful measure of patient functional status.
  • A study of 772,109 Medicare patients showed that factors such as age, race, and level of care significantly impacted the number of HDAH following trauma.
  • The findings indicate that higher level trauma centers lead to better outcomes in terms of HDAH, suggesting a need for future research on quality of life metrics post-discharge.

Article Abstract

Background: Quality benchmarking has recently evolved from a historical focus on short-term morbidity and mortality as the key metrics to assessing long-term outcomes. Long-term quality metrics have been shown to provide a more complete assessment of geriatric trauma care. Among these metrics, patients' average number of healthy days at home (HDAH) proports to be a useful administrative claims-based marker of patient functional status. Our goal was to determine the predictors of HDAH among injured older adults.

Methods: Medicare inpatient claims (2014-2015) were used to identify all geriatric trauma patients. Patients' number of HDAH was measured from the date of discharge and calculated as the total sum of patients' time during that period less any time spent in the hospital or emergency department, step-down/rehabilitation/nursing care, home health, or after death within a 365-period after index admission. Controlling for demographic, injury severity, and hospital-level characteristics, multivariable regression analyses were performed to identify the factors associated with increased HDAH.

Results: We included 772,109 geriatric trauma patients. The mean age was 82.15 years (SD, 8.49 years), 68.3% were female, and 91.6% were White. The median HDAH was 351 days (interquartile range, 351-355 days). After adjusted analysis, age, Black race, Charlson Comorbidity Index (CCI), and care at a level 3/nontrauma center were associated with fewer HDAH within 365 days after discharge.

Conclusion: This study suggests that higher level trauma centers provide more HDAH after index admission for injured older adults. Future studies should focus on correlating HDAH with more granular but less readily accessible quality of life metrics.

Level Of Evidence: Prognostic and Epidemiological; III.

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Source
http://dx.doi.org/10.1097/TA.0000000000004542DOI Listing

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