Resource Over Utilization Due To Serious Alcohol Related Injuries

由于严重的酒精相关伤害导致资源过度利用

• 批准号: 7580057
• 负责人: Bahman Sayyar Roudsari
• 金额: $ 17.96万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-10 至 2012-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7580057
• 关键词: Abdomen; Accident and Emergency department; Acute; Address; Admission activity; African American; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholism; Alcohols; Ambulances; Basic Life Support; Blood alcohol level measurement; Caring; Cause of Death; Cervical spine; Characteristics; Chest; Clinical Trials; Clinical Trials Design; Confounding Factors (Epidemiology); Data; Data Set; Databases; Dependence; Diagnosis; Diagnostic; Disadvantaged; Economic Burden; Economics; Effectiveness; Emergency Medical Technicians; Emergency medical service; Equilibrium; Ethnic Origin; Fluid Therapy; Frequencies; Gender; Head; Healthcare; Healthcare Systems; Hispanics; Hospital Costs; Hospitalization; Hospitals; Hour; IV Fluid; Incidence; Individual; Injury; Institutes; International; Intervention; Interview; Intoxication; Intratracheal Intubation; Legal; Length; Length of Stay; Life; Link; Medical; Medical center; Methods; Minority; Monitor; Not Hispanic or Latino; Outcome; Participant; Patient Self-Report; Patients; Pattern; Persons; Population Group; Procedures; Process; Questionnaires; Race; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Registries; Relative (related person); Research; Research Project Grants; Resources; Risk; Roentgen Rays; Safety; Sampling; Scanning; Severities; Source; System; Texas; Time; Trauma; United States; Universities; Vehicle crash; Woman; X-Ray Computed Tomography; age group; alcohol screening; base; brief alcohol intervention; brief intervention; cost; drinking; ethnic difference; experience; health care service utilization; high risk drinking; improved; injured; male; minority subjects; mortality; patient registry; programs; public health relevance; recidivism; sedative; service utilization; sex; trafficking; trauma centers

DESCRIPTION (provided by applicant): In spite of the well-researched influence of alcohol on injury incidence and the socio-economic consequences of injuries in the US, only a few studies have compared utilization of health care resources between alcohol and non-alcohol involved injuries. The few studies that do exist had one or more of the following limitations. First, they only focused on acute intoxication as a predictor of over-utilization of health services. Therefore, the potential influence of dependence to alcohol on resource utilization has seldom been the topic of research. Second, they relied solely on trauma registries that have very limited information about - alcohol consumption, resource utilization and cost estimation. Third, pre-hospital resource utilization has not been taken into consideration. Fourth, they did not differentiate between early (first 24 hours of emergency department (ED) arrival) and late (after the first 24 hours of ED arrival) resource utilization. Fifth, the influence of sex and race/ethnicity as potential variables which may modify the association between alcohol consumption and pre-hospital and hospital resource utilization, has not been evaluated. By linking four databases related to injuries from an urban level I trauma center, the current study proposes to estimate the extra-burden of injuries imposed by individuals with high BAC in the ED and/or dependence to alcohol on emergency medical service (EMS) system and the hospital health care system. We will place special emphasis on sex and race/ethnicity as potential effect modifiers. The primary strength of the proposed study is using data from a clinical trial that has detailed information about alcohol consumption, beyond acute BAC in the ED, for trauma patients. The specific aims of the proposed study are: 1) To compare the pre-hospital resource utilization between alcohol- and non-alcohol involved injuries; 2) To compare the cost of pre-hospital care between alcohol- and non-alcohol involved injuries; 3) To compare the early vs. late hospital resource utilization (i.e., procedures conducted in the first twenty four hours following admission vs. thereafter) between alcohol- and non-alcohol involved injuries; 4) To compare the cost of hospital care between alcohol- and non-alcohol involved injuries; 5) To evaluate whether sex or race/ethnicity modifies the association between alcohol consumption and over- utilization of pre-hospital and hospital resource use and cost of care; 6) To evaluate the validity of using "multiple imputation" method for dealing with missing data in studies that use trauma registries with more than 60% missing values for BAC in the ED. The proposed study will provide evidence as to the necessity of improving existing or implementing new alcohol screening programs in large urban level I trauma centers that are responsible for providing care to the most disadvantaged groups of the population. PUBLIC HEALTH RELEVANCE: Alcohol is involved in 40-50% of the hospitalizations in level I and II trauma centers. This study evaluates the extra-health care utilization due to alcohol-involved injuries in pre-hospital and in-hospital setting, after adjustment for potential confounding variables. In this study, we will place special emphasis on gender and race/ethnicity as potential variables that might influence the association between blood alcohol concentration and resource utilization in trauma centers. The primary strength of the proposed study is linking pre-hospital and hospital data to a clinical trial that has detailed information about alcohol consumption pattern, beyond acute blood alcohol concentration in the emergency department for trauma patients. The proposed study will provide evidence as to the necessity of improving existing or implementing new alcohol screening programs in large urban level I and II trauma centers that are responsible for providing care to the most disadvantaged groups of the population.

描述（由申请人提供）：尽管酒精对伤害发生率和美国伤害的社会经济后果的研究有充分研究，但只有少数研究比较了涉及酒精和非酒精之间的医疗保健资源受伤。确实存在的少数研究具有以下一个或多个局限性。首先，他们仅专注于急性中毒，作为过度利用卫生服务的预测指标。因此，对酒精对资源利用的潜在影响很少是研究的主题。其次，他们仅依赖于有关饮酒，资源利用和成本估算的信息非常有限的创伤注册表。第三，尚未考虑院前资源利用。第四，他们没有区分早期（急诊室（ED）到达）和较晚（ED到达的前24小时）资源利用率的早期（ED）。第五，尚未评估性别和种族/种族作为潜在变量的影响，这些变量可能会改变饮酒与院前和医院资源利用之间的关联。通过将与城市I级创伤中心的伤害有关的四个数据库链接，当前的研究提议估计ED中较高BAC和/或对酒精对紧急医疗服务（EMS）系统造成的额外的伤害负担。和医院医疗保健系统。我们将特别强调性别和种族/种族作为潜在效果修饰符。拟议研究的主要优势是使用临床试验的数据，该试验具有有关饮酒的详细信息，除了ED中的急性BAC外，还针对创伤患者。拟议的研究的具体目的是：1）比较酒精和非酒精之间的院前资源利用涉及伤害； 2）比较酒精和非酒精之间的院前护理费用涉及伤害； 3）比较早期与晚期医院的资源利用率（即，在入院后的前二十四小时与此后的酒精饮料之间进行的二十四个小时进行的程序涉及伤害； 4）比较酒精和非酒精之间的医院护理费用涉及伤害； 5）评估性别或种族/种族是否会改变饮酒和过度利用院前和医院资源使用以及护理成本之间的关联； 6）评估使用“多重归档”方法处理缺失数据的有效性，该研究使用ED中BAC的创伤注册表中缺少60％以上的数据。拟议的研究将提供证据表明在大型城市级创伤中心中改善现有或实施新的酒精筛查计划的必要性，该计划负责为最不利的人群提供护理。 公共卫生相关性：酒精涉及I级和II级创伤中心住院的40-50％。这项研究在调整了潜在的混杂变量后，评估了由于院前和院内环境中酒精涉及的伤害而导致的健康外护理利用。在这项研究中，我们将特别强调性别和种族/种族，作为可能影响创伤中心血液酒精浓度与资源利用之间关联的潜在变量。拟议的研究的主要优势是将院前和医院数据与临床试验联系起来，该试验具有有关饮酒模式的详细信息，除了急诊科急性血液酒精浓度的创伤患者外。拟议的研究将提供证据表明在大型城市I和II级创伤中心中改善现有或实施新的酒精筛查计划的必要性，这些计划负责为最弱势群体的人群提供护理。