Citation

Carter MW, Porell FW. J. Am. Geriatr. Soc. 2011; 59(3): 406-416.

Affiliation

From the *Center on Aging and Department of Community Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia; and †Gerontology Department and Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts.

Copyright

(Copyright © 2011, John Wiley and Sons)

DOI

10.1111/j.1532-5415.2010.03283.x

PMID

21391931

Abstract

OBJECTIVES: To examine the long-term effect of sentinel injury (unintentional injury involving serious health-related consequences) among older adults on Medicare expenditures. DESIGN: Secondary data analysis of the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare Beneficiaries. SETTING: Noninstitutionalized community dwellers. PARTICIPANTS: Older adults (N=12,318) continuously enrolled in Medicare Fee-for-Service under Old Age Survivors Insurance Benefits surveyed between October 1998 and December 2004. MEASUREMENTS: Monthly total Medicare expenditures served as the dependent variable. Injury status (preinjury, injury episode, postinjury) was identified from Medicare claims and specified as a set of dummy variables. Injury episodes began with the first index injury claim identified and ended when no further injury claims were found within 180 days. Population-averaged models using generalized estimating equation techniques were estimated to explore changes in Medicare expenditures over time after adjusting for casemix differences. A case-crossover design was used to compare monthly Medicare expenditures before and after sentinel injury events. RESULTS: Fifteen percent of beneficiaries sustained at least one sentinel injury. Medicare expenditures increased sharply during sentinel injury episodes (=1.703, P<.001) and remained at least 28% higher than would otherwise be expected for 27 uninterrupted months following injury. Additive Medicare expenditures associated with sentinel injury over 3 years were estimated at $28,885. CONCLUSION: Consequences of sentinel injury in older adults extend well beyond the period typically considered to be an acute injury episode. Better understanding of the long-term consequences of injury-related outcomes is needed to achieve public health goals of reducing injury and improving injury-related medical care.

Language: en