Dissertation

The Cost Implications of Fall-Related Injuries

Bohl, Alex A

2011

Overview

Falls in the older adult population are a substantial burden on the public's health and the nation's health care expenditures. Much is known about the epidemiology of falls and strategies to prevent falls, but comparatively little is known about fall-related injuries—particularly the cost implications of such injuries. The recent emphasis on comparative- and cost-effectiveness research as a strategy to improve the quality of health services is a step toward evidence-based public health and health care policy. Sound research and methodological techniques are needed in order to help researchers and policymakers develop effective fall prevention guidelines. This dissertation focuses on the cost implications of fall-related injuries in 3 distinct aims. Chapter 2 (Manuscript 1) presents a descriptive study of the components of health care costs associated with increased costs after a medical fall for fallers admitted to hospital for initial injury compared to those who were not admitted. The results suggest that inpatient and long-term care drive the increase in costs for admitted fallers, while outpatient and \"other\" (e.g., skilled nursing and home health) drive cost increases for nonadmitted fallers. Chapter 3 (Manuscript 2) describes a cost-benefit analysis comparing Tai Chi to multifactorial interventions to prevent medical falls. The key finding of this study is that Tai Chi has a more favorable net present value, number of medical falls prevented, and incremental cost-effectiveness ratio compared to all other alternatives, but multifactorial rehabilitation has the largest impact on its targeted medical fall rate. The study presented in Chapter 4 (Manuscript 3) seeks to improve the science of economic evaluation by comparing existing statistical models used to analyze cost data to a newly developed approach: Generalized Additive Models for Location, Scale, and Shape (GAMLSS). The analysis suggests that Generalized Linear Models (GLMs) with log link and Gamma family perform better than GAMLSS when analyzing health care cost data. Overall, these 3 papers address different aspects of the economic evaluation of fall-related injuries and have the following main findings: (1) the components driving costs after a medical fall differ by injury severity and over time; (2) public health interventions might produce the highest value opportunity for medical fall prevention, but targeted clinical interventions might have the highest comparative effectiveness; (3) cost distributions resembling those of our medical fallers' dataset are a challenge for statistical models, and GAMLSS—a new approach with potential to overcome these challenges—is not necessarily an improvement over traditional GLMs.

• Publisher: ProQuest Dissertations & Theses
• Subject: Aging / Falls / Health care expenditures / Injuries / Older people / Public health
• ISBN: 9781124599779, 1124599770