A Probe Into The Factors Affecting The Economic Burden Of Children And Adolescents' Falls In Shanxi Province

Falls have caused a heavy burden in health and economics on children and their families.The economic burden of disease not only increases the costs of the family,but also causes the losses of social wealth.Understanding the influencing factors of the economic burden of the disease is of great significance in reducing the economic burden of the disease.At present,the research on the factors affecting the economic burden of the falls is limited to the quantitative research on the direct medical economic burden and the indirect economic burden.We made a systematic and comprehensive study on the factors affecting the economic burden of child and adolescent falls by combing Delphi method,quantitative research and qualitative research from experts,medical institutions and patients.Objective:Through comprehensive research on experts,medical institutions,and patients,we systematically and comprehensively understand the factors affecting the economic burden of falls,and provide new research ideas for the prevention and treatment of diseases and injuries.Meanwhile,we provide a theoretical basis for formulating policies for the prevention and treatment of falls.Methods:1.Through the literature research,the index system is preliminarily formulated.Through the Delphi method,after three rounds of expert consultation,a three-level index system for “influencing factors of the economic burden due to falls of children and adolescents aged 0 to 24” is constructed.2.Seven third-grade class-A hospitals were selected in the northern part of Shanxi Province(Datong),Central(Taiyuan),and South(Yuncheng).The whole medical records of 2,823 children aged 0 to 14 years old hospitalized due to falls were selected from January 2008 to December 2013.The influencing factors of hospitalization expenses for hospitalized children due to falls were analyzed by t test,analysis of variance and multiple linear regression.3.The information of the views about the falls and the economic burden due to falls from12 families whose children were accepted by hospital were collected as the method of qualitative research.According to the theory of grounded theory,the data was graded three levels and inducted into a grounded theory.Results:1.The authoritative coefficient of expert consultation results is 0.813,which means the results is accurate.The P value of the Kendall coordination coefficient in the three rounds expert consultation are less than 0.001,indicating that the experts have reached an agreement on the content of the consultation,the third round of coordination coefficient W(0.539)is better than the second round(0.344),the second round of coordination coefficient W is better than In the first round(0.235),as the number of consultations increased,the experts were reached an agreement.After three rounds of consultation,the third-level indicator system of “influencing factors of the economic burden due to falls of children and adolescents aged 0 to 24” was finally constructed,which included 54 indicators from first-,second-and thirdlevel.The first-level indicators include the factors affecting the direct economic burden,the indirect economic burden,and the intangible economic burden.Among them,the direct economic burden factors include social environmental factors,medical service factors,patient family factors,patients' own factors and the occurrence of falls.Indirect economic burden factors include three secondary indicators: per capita GDP factor,DALYs factor and productivity weight factor.Influential factors of intangible economic burden include two secondary indicators: the impact of disease and family risk-taking ability.2.Multiple linear regression analysis found that with reference of 0 years old,10 to 14 years old was the risk factor for the increase of log-10 transformed total hospitalization expenses(P < 0.001);with reference to walking,taking physical activity(P = 0.01)and taking leisure activities(P = 0.01)were risk factors for the increase of log-10 transformed total hospitalization expenses;reference to the head and neck,chest and abdomen(P < 0.001)and multiple site injuries(P = 0.01)were risk factors for the increase of log-10 transformed total hospitalization expenses;with superficial injury as reference,intracranial injury(P < 0.001)is a risk factor for the increase of log-10 transformed total hospitalization expenses;with reference of hospitalization is generally,hospitalization is urgent(P = 0.06)and critical(P < 0.001)is a risk factor for the increase of log-10 transformed total hospitalization expenses;with reference of non-surgical treatment,surgical treatment(P < 0.001)is a risk factor for the increase of log-10 transformed total hospitalization expenses;with reference of death,Effective outcome(P = 0.02)and loss of follow-up(P = 0.03)were protective factors for the increase of log-10 transformed total hospitalization expenses;with reference of no complications,complications(P < 0.001)is a risk factor for the increase of log-10 transformed total hospitalization expenses;log-10 transformed hospital length(P < 0.001)is a risk factor for the increase of log-10 transformed total hospitalization expenses.3.From November 6,2018 to December 5,2018,a purposeful sampling and an opportunity sampling method were used to conduct in-depth interviews with 12 hospitalized children and adolescents and their accompanying family members in a third-grade class-A hospital in Shanxi Province.The interview time was 10~30 minutes,the total interview time was 209.3 minutes,and the transcription recording text was 52,000 words.Based on interview data,a grounded theory is established: targeted disease prevention measures can greatly reduce the social costs in many areas.The core generic is defined as "cost." There are 3 secondary codes,namely: "occurrence of injury","cost of treatment period","cost of rehabilitation period".Among them,“the occurrence of injury” includes two first-level codes,“cognition of fall injury” and “external environment when falling”;“cost of treatment period” includes three first-level codes,“choosing quality medical resources”,“not taking care of other things” and “increased cost of living”;“cost of rehabilitation period” includes two firstlevel codes: “family dysfunction” and “various problems in the future”.Conclusion:1.Experts believe that the factors affecting the economic burden of direct economic burden are of great importance to the economic burden of children and adolescents falls,while the factors affecting indirect economic burden and intangible economic burden are less important to the economic burden of children and adolescents falls.2.Quantitative analysis of hospitalization data found that variables(age)that reflect children's physical and mental development and behavioral characteristics,as well as related variables that reflect the severity of the injury(eg,injury site,severity of injury,length of hospital stay,etc.)have an impact on hospitalization costs.3.The qualitative study found that the severity of the injury caused by the falls is the influencing factor of the number of related problems caused by the treatment period and the rehabilitation period and the duration of the impact.Severe injuries can lead to a heavier economic burden of the disease.4.The three-part study found that the severity of injury caused by a fall injury is an important factor affecting the economic burden of children and adolescents,not only affecting the direct economic burden,but also affecting the indirect economic burden and the intangible economic burden.