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Keywords:

  • older adults;
  • injury;
  • sentinel injury;
  • Medicare costs

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 (inline image=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.