Trends in incidence, health care use and costs for subtrochanteric femur fractures in the Netherlands 2000-2019.

OBJECTIVE: This study aimed to provide population based trends in incidence rate, hospital length of stay (HLOS), trauma mechanism, and costs for healthcare and lost productivity of subtrochanteric femur fractures in the Netherlands. METHODS: Data on patients with subtrochanteric femur fractures sustained between January 1, 2000 and December 31, 2019 were extracted from the National Medical Registration of the Dutch Hospital Database. Incidence rates, HLOS, health care and productivity costs were calculated in sex- and age-specific groups. RESULTS: A total of 14,399 patients sustained a subtrochanteric fracture in the 20-year study period. Incidence rates in the entire population dropped by 15.5 % from 4.5 to 3.8 per 100,000 person years (py). This decline was larger in women (6.4 to 5.2 per 100,000 py, -19.8 %) than in men (2.6 to 2.5 per 100,000 py, -4.0 %). HLOS declined by 62.5 % from a mean of 21.6 days in 2000-2004 to 8.1 days in 2015-2019. Subtrochanteric fractures were associated with total annual costs of €15.5 M, of which 91 % (€14.1 M) were health care costs and €1.3 M were costs due to lost productivity. Mean healthcare costs per case were lower in men (€16,394) than in women (€23,154). CONCLUSION: The incidence rates and HLOS of subtrochanteric fractures in the Netherlands have decreased in the 2000-2019 study period and subtrochanteric fractures are associated with a relatively small total annual cost of €15.5 M. Increasing incidence rates and a bimodal age distribution, described in previous studies from other European countries, were not found in the Dutch population.

Trends in incidence, health care consumption, and medical and productivity costs of femoral shaft fractures in the Netherlands between 2005 and 2019.

INTRODUCTION: Population-based knowledge on the occurrence of femoral shaft fractures is necessary for allocation of health care services, optimization of preventive measures, and research purposes. This nationwide study aimed to provide an overview on the incidence of femoral shaft fractures over a 15-year period and to gain insight into health care consumption and work absence with associated costs in the Dutch population. METHODS: Data of patients who sustained an acute femoral shaft fracture in the years 2005-2019 were extracted from the National Medical Registration of the Dutch Hospital Database. The incidence rate, hospital length of stay (HLOS), direct medical costs, productivity costs, and years lived with disability were calculated for age- and gender specific groups. RESULTS: A total of 15,847 patients with a femoral shaft fracture were included. The incidence rate increased with 13 % over this 15-year period (5.71/100,000 persons per year in 2005 and 6.47/100,000 in 2019). The mean HLOS per patient was 13.8 days in 2005-2009 versus 8.4 days in 2015-2019 for the entire group. Mean HLOS per patient increased with age (10.0 days for age group 0-9 and 12.7 days for age group >80), but declined over time from 13.6 days in 2005-2009 to 8.8 days in 2015-2019 in males, and from 13.7 days and to 8.2 days, respectively, in females. The costs due to work absence was higher in males. Cumulative health care costs were highest in females >80 years (8.4 million euros versus 1.6 million in males). CONCLUSION: The incidence rate of femoral shaft fractures increased over the past 15 years in the Netherlands. Mean HLOS per patient has decreased in all age groups and in both sexes. Health care costs were highest for female octogenarians.

Increasing incidence of ED-visits and admissions due to traumatic brain injury among elderly patients in the Netherlands, 2011-2020.

BACKGROUND AND IMPORTANCE: Traumatic brain injury (TBI) is a leading cause of disability and mortality worldwide. Nowadays the highest combined incidence of TBI-related emergency department (ED) visits, hospitalizations and deaths occurs in older adults. Knowledge of the changing patterns of epidemiology is essential to identify targets to enhance prevention and management of TBI. OBJECTIVE: To examine time trends of ED visits, admissions, and mortality for TBI comparing non-elderly and elderly people (aged ≥ 65 years) in the Netherlands from 2011 to 2020. DESIGN: We conducted a retrospective observational, longitudinal study of TBI using data from the Dutch Injury Surveillance System (DISS) and Statistics Netherlands from 2011 to 2020. OUTCOME MEASURE AND ANALYSIS: The main outcome measures were TBI-related ED visits, hospitalizations, and mortality. Temporal trends in population-based incidence rates were evaluated using Poisson regression. We compared patients under 65 years and patients aged 65 years or older. MAIN RESULTS: From 2011 to 2020, absolute numbers of TBI related ED visits increased by 244%, and hospital admissions and mortality showed an almost twofold increase in patients aged 65 years and older. The incidence of TBI-related ED visits and hospital admission increased also in elderly adults, with 156% and 51% respectively, whereas the mortality remained stable. In contrast, overall rates of ED visits, admissions, and mortality, and causes for TBI did not change in patients younger than 65 years during the study period. CONCLUSION: This trend analysis shows a significant increase of ED-visits and hospital admission for TBI in elderly adults from 2011 to 2020, whereas the mortality remained stable. This increase cannot be explained by the aging of the Dutch population alone, but might be related to comorbidities, causes of injury, and referral policy. These findings strengthen the development of strategies to prevent TBI and improve the organization of acute care necessary to reduce the impact and burden of TBI in elderly adults and on healthcare and society.

Reconsidering injury severity: Looking beyond the maximum abbreviated injury score.

BACKGROUND: Injury severity is often determined by anatomical measures such as the Maximum Abbreviated Injury Score (MAIS). Yet, it is suggested that MAIS provides a limited view on injury severity as the overall burden of trauma is multidimensional, including psychological problems and health care costs for example. It is unclear if MAIS as a single criterion can serve as a proper indicator for overall injury severity, since it has not been compared with other severity measures for different types of injuries. Consequently, scientists and policymakers using MAIS as primary measure for injury severity may have insufficient information for prioritizing prevention policy and research. This study explores the relation between MAIS and other injury severity measures for ten different injury types to determine if MAIS is indicative for the overall burden of trauma. METHODS: Trauma patients filled in a questionnaire six months after they visited an emergency department in the Netherlands. In total, 3.698 patients registered in the Dutch Injury Surveillance System responded. The following injury types are included: injuries to the head-brain, face, spinal cord, internal organs, upper and lower extremities, and hips. The questionnaire consisted of questions about the impact of patients' injury regarding quality of life (EQ-5D+), perceived severity, subjective distress (IES-R), anxiety and depression (HADS) and healthcare use. RESULTS: Logistic regression showed that MAIS was significantly related to hospital stay, quality of life and cognitive complaints. A lack of association was found between MAIS and perceived severity, distress, anxiety and depression. Furthermore, Z-score analysis showed that the relation between severity measures differs between injury types. CONCLUSIONS: MAIS is an anatomical-based discriminative measure for injury severity that correlates with several other severity measures including hospital stay and healthcare costs. However, MAIS is not always a proper indicator for severity when severity involves the patient's psychological burden or perceived health status. In sum, the accuracy of MAIS as an indicator for injury severity depends on the definition of severity and the injury type. Therefore, caution is needed when using and interpreting MAIS as an indicator for injury severity in research or policymaking.

The burden of disease of fatal and non-fatal burn injuries for the full spectrum of care in the Netherlands.

BACKGROUND: A comprehensive overview of the burden of disease of burns for the full spectrum of care is not available. Therefore, we estimated the burden of disease of burns for the full spectrum in the Netherlands in 2018, and explored whether the burden of disease changed over the past 5 years (2014-2018). METHODS: Data were collected at four levels: general practice, emergency department, hospital, and mortality data. For each level, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life-years (DALY) were estimated using a tailored methodology. RESULTS: Burns resulted in a total of 9278 DALYs in the Netherlands in 2018, comprising of 7385 YLDs (80%) and 1892 YLLs (20%). Burn patients who visited the general practice contributed most DALYs (64%), followed by deceased burn patients (20%), burn patients admitted to hospital (14%) and those treated at the emergency department (2%). The burden of disease was comparable in both sexes (4734 DALYs (51%) for females; 4544 DALYs (49%) for males), though the distribution of DALYs by level of care varied; females contributed more DALYs at the general practice level, and males at all other levels of care. Among children boys 0-4 years had the highest burden of disease (784 DALYs (9%)), and among adults, females 18-34 years old (1319 DALYs (14.2%)) had the highest burden of disease. Between 2014 and 2018 there was a marginal increase of 0.8% in the number of DALYs. CONCLUSIONS: Burns cause a substantial burden of disease, with burns requiring care at the general practice level contributing most DALYs. Information on burden of burns by the full level of care as well as by subgroup is important for the development of tailored burn prevention strategies, and the updated figures are recommended to be used for priority setting and resource allocation.

Anxiety, depression and post-traumatic stress symptoms among injury patients and the association with outcome after injury.

Background: Injury patients are at risk for mental health problems, which could result in slower recovery and affect health-related quality of life (HRQoL), health care utilization, and return to work (RTW). Objective: In this study, we determined the prevalence of symptoms indicative of probable depression, anxiety, and post-traumatic stress disorder (PTSD) and their association with HRQoL, health care utilization, and RTW in adult injury patients. Method: Data on unintentional injuries in adult patients were retrieved from the Dutch Injury Surveillance System (DISS) and a six-month follow-up questionnaire that included the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) to assess depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and items on HRQoL (measured with the EQ-5D-5 L and EQ visual analogue scale), health care utilization and RTW. Logistic regression analyses assessed the association between depression, anxiety, and PTSD and HRQoL, health care utilization, and RTW. Results: At six months post-injury, 22% (n = 665/3060) of included patients had scores indicative of probable anxiety disorder (14%), depression (16%), and/or PTSD (6%). These patients had reduced EQ-5D utility scores [ß: -0.26 (95% CI: -0.28, -0.23)] and were less likely to RTW [OR: 2.12 (95% CI: 1.34, 3.37)] compared to their counterparts. Both mental and physical health care utilization were significantly higher in patients with symptoms indicative of depression, anxiety, and/or PTSD. Conclusions: In injury patients, there is a high occurrence of depression, anxiety, and PTSD symptoms, which is associated with lower HRQoL, higher health care utilization, and lower RTW rates. These results underline the importance of screening and treatment of these symptoms in this population to enhance good recovery of injury patients.

Antecedentes: Los pacientes lesionados se encuentran en riesgo de desarrollar problemas de salud mental, los cuales podrían resultar en recuperación más lenta y podrían afectar la calidad de vida relacionada con la salud (HRQoL en sus siglas en inglés), la utilización de los servicios de salud, y el retorno al trabajo (RTW en sus siglas en inglés).Objetivo: En este estudio, determinamos la prevalencia de síntomas indicativos de probable depresión, ansiedad y de trastorno de estrés postraumático (TEPT) y su asociación con la HRQoL, con la utilización de servicios de salud, y el RTW en pacientes adultos lesionados.Método: Se recuperaron datos de pacientes adultos con lesiones no intencionales desde el Sistema Holandés de Vigilancia de Lesiones (DISS) y desde un cuestionario a los seis meses de seguimiento que incluyó la Escala Hospitalaria de Ansiedad y Depresión (HADS) y la Escala -revisada- del Impacto del Evento (IES-R) para evaluar síntomas de depresión, ansiedad y estrés postraumático (TEPT), también ítems sobre HRQoL (medida con la escala EQ-5D-5 L y la escala visual análoga EQ), utilización de servicios de salud, y RTW. Se aplicó análisis de regresión logística para evaluar la asociación entre depresión, ansiedad y TEPT y la HRQoL, utilización de servicios de salud y RWT.Resultados: A los 6 meses de seguimiento tras la lesión, el 22% (n = 665/3060) de los pacientes incluidos tuvo puntajes indicativos de probable trastorno de ansiedad (14%), depresión (16%) y/o TEPT (6%). Estos pacientes habían reducido los puntajes de la escala EQ-5D [ß: −0.26 (95% CI: −0.28,-0.23)] y tuvieron menos probabilidad de RTW [OR: 2.12 (95% CI: 1.34, 3.37)] comparados con su contraparte. La utilización de servicios de salud tanto física como mental fue significativamente más alta en los pacientes con síntomas indicativos de depresión, ansiedad y/o TEPT.Conclusiones: En los pacientes lesionados, existe una alta incidencia de depresión, ansiedad y síntomas de TEPT, los cuales se asociaron con una menor HRQoL, mayor uso de servicios de salud, y menores tasas de RTW. Estos resultados subrayan la importancia del tamizaje y tratamiento de estos síntomas en esta población, para aumentar una buena recuperación de los pacientes lesionados.

Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands.

PURPOSE: This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures. METHODS: A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire. RESULTS: In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age. CONCLUSION: Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.

Incidence and treatment of hand and wrist injuries in Dutch emergency departments.

PURPOSE: The purpose of this study was to describe the epidemiology, treatment and costs of hand and wrist injuries presenting to the Dutch ED. With increasing medical costs and crowding of emergency departments (ED), a more detailed description of emergency department attendance of hand and wrist injuries and their treatment may help to facilitate more adequate allocation of health care services. METHODS: The Dutch Injury Surveillance System obtained a total of 160,250 hand and wrist injuries. Patient characteristics, incidence rates, type of injury, treatment, and costs were described. RESULTS: The incidence of hand and wrist injuries in the Netherlands in 2016 was 11 per 1000 in males and 8 per 1000 in females. This is about 25% of all injuries presented at the ED. Of all hand injuries, only 3% was directly admitted to the hospital or received emergency surgery. Thirty percent did not need further treatment in the hospital. CONCLUSION: The current data suggest that a substantial proportion of the hand and wrist injuries needed no subsequent specialized treatment. Although the severity of the injury could not be deduced from our data, the data suggest a ground for a more extensive role of primary health care (general) practitioners in the primary triage and treatment of hand and wrist injuries. This may reduce health care cost and help decongest the ED departments. Prospective studies are needed to confirm these preliminary conclusions. LEVEL OF EVIDENCE: III.

Health care utilization and health-related quality of life of injury patients: comparison of educational groups.

BACKGROUND: Differences in health care utilization by educational level can contribute to inequalities in health. Understanding health care utilization and health-related quality of life (HRQoL) of educational groups may provide important insights into the presence of these inequalities. Therefore, we assessed characteristics, health care utilization and HRQoL of injury patients by educational level. METHOD: Data for this registry based cohort study were extracted from the Dutch Injury Surveillance System. At 6-month follow-up, a stratified sample of patients (≥25 years) with an unintentional injury reported their health care utilization since discharge and completed the EQ-5-Dimension, 5-Level (EQ-5D-5L) and visual analogue scale (EQ VAS). Logistic regression analyses, adjusting for patient and injury characteristics, were performed to investigate the association between educational level and health care utilization. Descriptive statistics were used to analyse HRQoL scores by educational level, for hospitalized and non-hospitalized patients. RESULTS: This study included 2606 patients; 47.9% had a low, 24.4% a middle level, and 27.7% a high level of education. Patients with low education were more often female, were older, had more comorbidities, and lived more often alone compared to patients with high education (p < 0.001). Patients with high education were more likely to visit a general practitioner (OR: 1.38; CI: 1.11-1.72) but less likely to be hospitalized (OR: 0.79; CI: 0.63-1.00) and to have nursing care at home (OR: 0.66; CI: 0.49-0.90) compared to their low educated counterparts. For both hospitalized an non-hospitalized persons, those with low educational level reported lower HRQoL and more problems on all dimensions than those with a higher educational level. CONCLUSION: Post-discharge, level of education was associated with visiting the general practitioner and nursing care at home, but not significantly with use of other health care services in the 6 months post-injury. Additionally, patients with a low educational level had a poorer HRQoL. However, other factors including age and sex may also explain a part of these differences between educational groups. It is important that patients are aware of potential consequences of their trauma and when and why they should consult a specific health care service after ED or hospital discharge.

[The effect of the corona measures on the number of injuries treated at Emergency Departments]. / De invloed van coronamaatregelen op het aantal behandelde letsels op de SEH.

OBJECTIVE: To gain insight into the effect of the coronavirus measures on the number of severe injuries treated at Emergency Departments (EDs). DESIGN: Retrospective observational research. METHOD: We compared prevalences of ED visits from the Dutch Injury Surveillance System (DISS) between the period of semi-lockdown (16 March-10 May 2020) and the same period in 2019. The same comparisons were made for the period of relaxation of measures (11 May-5 July 2020) and for the period of relaxation versus lockdown. To eliminate a possible effect of avoiding emergency care, analyses were performed on severe injury related ED-visits. RESULTS: The prevalence of severe injury related ED-visits during the period of lockdown was 27 percent lower compared to the same period in 2019 (6.755 versus 4.902, P<0.05). This decrease was observed for all types of injuries and age groups, but was strongest for sports injuries (-53%) and among 10-19-year-olds (-55%). In contrast, the number of ED-visits increased after accidents with jobs in the house (+31%) and roller-skates (+223%). Among 0-11-year-olds, more accidents with trampolines were reported (+68%). During the period of relaxation, the number of severe injury related ED-visits increased with 19 percent, but was 11 percent lower compared to 2019. CONCLUSION: The changes in activities following the coronavirus measures have led to changes in the number of severe injuries treated at EDs. The variations observed during the periods of lockdown and relaxation seem to be correlated with the amount of exposure in sports, traffic, stay at home and leisure activity.

Prevalence of Post-Concussion-Like Symptoms in the General Injury Population and the Association with Health-Related Quality of Life, Health Care Use, and Return to Work.

Little is known about post-concussion-like symptoms in the general injury population and the association of these symptoms with outcome after injury. This study aimed to assess the prevalence of post-concussion-like symptoms in a general injury population and describe the association between post-concussion syndrome (PCS) and health-related quality of life (HRQL), health care use, and return to work. In this longitudinal study of a cohort of injury patients, data were collected 6 and 12 months after their Emergency Department visit. Questionnaires included socio-demographics, health care utilization, return to work and the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) to measure HRQL. The 12-month questionnaire included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In total, 282 (22.0%) of the 1282 patients met the criteria for PCS. Apart from the high prevalence of PCS in patients with head injuries (29.4%), a considerable proportion of non-head injury patients also had PCS (20.6%) a year after injury. Patients with PCS had lower HRQL, lower return to work rates, and higher health care utilization, compared to patients without PCS. This underlines the importance of developing strategies to prevent post-concussion-like symptoms among injury patients, raising awareness among patients and physicians on the occurrence of PCS, early detection of PCS in the general injury population, and development of strategies to optimize recovery in this group of injury patients, ultimately leading to lower the individual and economic burden of injury.

[Decrease in minor injury related visits to Emergency Departments coincides with higher numbers of primary care contacts]. / Stijging lichte letsels bij de huisarts valt samen met daling op de SEH.

OBJECTIVE: In the past 10 years, there has been a decrease in the number of patients who report to the Emergency Department (ED) every year for injuries from accidents or violence, especially in the subgroup of patients who did not require hospital admission. We investigated how the number of injury-related emergency department visits and GP contacts evolved over the period 2013-2017. DESIGN: Retrospective observational trend study. METHOD: To calculate the trend in emergency department visits in the Netherlands, we used data from the injury information system (LIS) for the period 2013-2017. To calculate the trend in GP contacts (GP practices as well as GP centres), we used data from the NivelZorgregistraties (Nivel medical records). In order to compare the trends, we distinguished between minor and major injuries. The numbers from the records were extrapolated to numbers for the whole of the Netherlands. RESULTS: In the period studied, the number of patients with minor injuries who visited the ED dropped by 38.5%, while the number of patients with major injuries (fractures and brain injuries) increased by 4.1%. In the same period, the number of GP contacts for minor injuries at GP practices increased by 25% and at GP centres by 43%; the number of primary care contacts for major injuries increased by 5.1% (GP practices) and 31% (GP centres) respectively. CONCLUSION: The role of general practitioners in the treatment of patients with minor injuries is increasing. The trend in major injuries is a better indicator for monitoring accidents and violence in the Netherlands. Conflict of interest and financial support: none declared.

Health care and productivity costs for isolated tibia shaft fracture admissions in The Netherlands.

The aim of this study was to provide a detailed overview of age and gender specific health care costs and costs due to lost productivity for hospital admitted patients with an isolated tibia shaft fracture in The Netherlands between 2008 and 2012. Injury cases and length of hospital stay were extracted from the National Medical Registration. Information on extramural health care and work absence were retrieved from a patient follow-up survey on health care use. Medical costs included ambulance care, in- hospital care, general practitioner care, home care, physical therapy, and rehabilitation/nursing care. An incidence-based cost model was applied to calculate direct health care costs and lost productivity in 2012. Total direct health care costs for all patients admitted with a tibia shaft fracture (n = 1,635) were €13.6 million. Costs for productivity loss were € 23.0 million. Total costs (direct health care and lost productivity) per patient were highest for men aged 40-49 years mainly due to lost productivity, and for women aged > 80 years, due to high direct medical costs.

Epidemiologic trends for isolated tibia shaft fracture admissions in The Netherlands between 1991 and 2012.

INTRODUCTION: Population-based knowledge on the occurrence of specific injuries is essential for the allocation of health care services, optimization of preventive measures, and research purposes. Therefore, the aim of this study was to examine long-term nation-based trends in the incidence rate, trauma mechanism, hospital length of stay (HLOS), treatment, and outcome of hospital-admitted patients with an isolated tibia shaft fracture between 1991 and 2012 in The Netherlands. METHODS: All hospital-admitted patients in The Netherlands between 1991 and 2012 with an isolated tibia shaft fracture were included. Age and gender-standardized incidence rates were calculated for each year. Data were extracted from the National Medical Registration. RESULTS: The incidence rate for men decreased to 13.8/100,000 person years (py). For women the incidence rate remained stable with 7.2/100,000 py. Incidence showed a peak for adolescent men (15-19 years), and increased in both genders from 65 years onwards. Since 1993 the mean HLOS for isolated tibia fractures reduced from 10.8 to 5.4 days. Mean HLOS increased with age. Mean years lived with disability (YLD) was 4.5 years, declined linearly with age, and showed no gender effect. CONCLUSIONS: In 22 years, the incidence rate of hospital admitted patients with an isolated tibia shaft fracture in The Netherlands dropped with 12%, which was mainly attributable to a 15% decline among men. Incidence rate, trauma mechanism, and HLOS were age and gender related. HLOS also reduced over time. Operation rate and YLD were only age related.

Health-related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension.

INTRODUCTION: The EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. However, the lack of a cognition dimension is generally felt as disadvantageous as many injuries involve cognitive effects. We aimed to assess the added value of a cognitive dimension in a cohort of injury patients. METHODS: We analyzed EQ-5D-3L extended with cognition (EQ-5D + C) dimension responses of 5346 adult injury patients. We studied dimension dependency, assessed the additional effect of the cognitive dimension on the EQ-VAS, and, using the EQ-VAS as a dependent variable, determined the impact of EQ-5D and EQ-5D + C attributes in multivariate regression analyses. RESULTS: Extreme cognitive problems combined with no problems on other dimensions are uncommon, whereas severe problems on other dimensions frequently occur without cognitive problems. The EQ-VAS significantly decreased when cognitive problems emerged. Univariate regression analyses indicated that all EQ-5D + C dimensions were significantly associated with the EQ-VAS. Exploratory analyses showed that using any set of five of the six EQ-5D + C dimensions resulted in almost identical explained variance, and adding the remaining 6th dimension resulted in a similar additional impact. CONCLUSIONS: The addition of the cognition dimension increased the explanatory power of the EQ-5D-3L. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions.

Fall-related healthcare use and mortality among older adults in the Netherlands, 1997-2016.

OBJECTIVES: Fall-related injuries are a leading cause of morbidity among older adults, leading to a high healthcare consumption and mortality. We aim to describe and quantify time trends of fall-related healthcare use and mortality among adults aged ≥65 years in the Netherlands, 1997-2016. DESIGN: Data were extracted from the Dutch Injury Surveillance System, Dutch Hospital Discharge Registry, and Cause-of-Death Statistics Netherlands, by age, sex, diagnosis, injury location, and year. MEASUREMENTS: Absolute numbers and age-standardized rates of fall-related Emergency Department (ED) visits, hospital admissions, and fatalities, as well as average length of hospital stay (LOS) were calculated. RESULTS: Between 1997 and 2016, absolute numbers of fall-related ED visits increased by 48%, hospital admissions increased by 59%, and mortality showed an almost threefold increase. These absolute numbers doubled among adults aged ≥85 years. A shift in fall-related injury diagnosis was observed over the years with a growing share of skull/brain injuries. In contrast to the increase in absolute numbers, standardized incidence rates of ED visits decreased by 30% (p = 0.00), whereas incidence rates of hospital admissions and mortality did not significantly change over time. Furthermore, the absolute number of hospital admission days almost halved, due to a reduced average LOS from 18.5 (95% confidence interval (CI): 18.2-18.8) days (1997) to 6.1 (95% CI, 6.1-6.2) days (2016). CONCLUSION: Even though the standardized incidence rates of ED visits decreased in the past twenty years, the absolute number of fall-related ED visits increased. The number of hospital admissions has also increased, but the total number of admission days has almost halved during the same period. If the observed trends would continue, this may have implications for healthcare resource allocation, as the burden of care in EDs increases, and the admission duration reduces.

Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review.

OBJECTIVES: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. DESIGN: Systematic review of economic evaluations on falls prevention programs. SETTING: Studies (N=31) of community-dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. PARTICIPANTS: Adults aged 60 and older. MEASUREMENTS: Information on study characteristics and health economics was collected. Study quality was appraised using the 20-item Consensus on Health Economic Criteria. RESULTS: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two-thirds of all reported incremental cost-effectiveness ratios (ICERs) with quality-adjusted life-years (QALYs) as outcome were below the willingness-to-pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. CONCLUSION: The majority of the reported ICERs indicated that falls prevention programs were cost-effective, but methodological differences between studies hampered direct comparison of the cost-effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost-effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost-effective type of program for community-dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost-effective type of program for older adults living in a residential care facility. J Am Geriatr Soc 66:2197-2204, 2018.

Increased care demand and medical costs after falls in nursing homes: A Delphi study.

AIMS AND OBJECTIVE: To estimate the increased care demand and medical costs caused by falls in nursing homes. BACKGROUND: There is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence-based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding. DESIGN: A three-round Delphi study. METHODS: A panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best-case, a typical-case and a worst-case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages. RESULTS: In case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst-case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170. CONCLUSIONS: Falls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls. RELEVANCE TO CLINICAL PRACTICE: This study could aid decision-making on investing in appropriate implementation of falls prevention interventions in nursing homes.

The economic burden of injury: Health care and productivity costs of injuries in the Netherlands.

BACKGROUND: Detailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex. METHOD: Injury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model. RESULTS: Total costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15-54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15-24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient. CONCLUSION: Our detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.

Trends in incidence rate, health care consumption, and costs for patients admitted with a humeral fracture in The Netherlands between 1986 and 2012.

INTRODUCTION: This study aimed to examine long-term population-based trends in the incidence rate of patients with a humeral fracture admitted to a hospital in the Netherlands from 1986 to 2012 and to give a detailed overview of the health care consumption and productivity loss with associated costs. MATERIALS AND METHODS: Age and gender-standardised incidence rates of hospital admissions for patients with a proximal, shaft, or distal humeral fracture were calculated for each year (1986-2012). Injury cases, length of hospital stay (LOS), trauma mechanism, and operation rate were extracted from the National Medical Registration. An incidence-based cost model was applied to calculate costs for direct health care and lost productivity in 2012. RESULTS: Between 1986 and 2012 112,910 patients were admitted for a humeral fracture. The incidence rate increased from 17.8 in 1986 to 40.0 per 100,000 person years in 2012. Incidence rates of proximal fractures increased the most, especially in elderly women. Operation rates decreased in patients aged 70 years or older. The mean LOS decreased from nine days in 1997 to five days in 2012. The cumulative LOS of all patients in 2012 was 28,880 days of which 73% were caused by women and 81% were caused by patients aged 50 years or older. Cumulative medical costs in 2012 were M€55.4, of which M€43.4 was spent on women. Costs increased with age. Costs for hospital care contributed most to the overall costs per case until 70 years of age. From 70 years onwards, the main cost determinants were hospital care, rehabilitation/nursing care, and home care. Cumulative costs due to lost productivity were M€23.5 in 2012. Costs per case increased with age in all anatomic regions. CONCLUSIONS: The crude number of patients admitted for a humeral fracture increased 124% in 27 years, and was associated with age and gender. Proximal fractures in elderly women accounted most significantly for this increase and most of the costs. The main cost determinants were hospital care and productivity loss.